The Pharmaceutical Journal
Vol 269 No 7214 p311
7 September 2002

This article
Reprint
Photocopy

News summary

Related websites
New England Journal of Medicine (content.nejm.org)

Broad-spectrum antifungal for invasive aspergillosis launched

A broad-spectrum triazole antifungal agent, voriconazole (Vfend), primarily for use in immunocompromised patients with progressive, possibly life-threatening infections, is being launched this week by Pfizer (see p317).

Voriconazole is licensed for the treatment of invasive aspergillosis, fluconazole-resistant serious invasive candida infections and serious fungal infections caused by Scedosporium spp and Fusarium spp in patients aged two years and older.

In a study published recently in The New England Journal of Medicine researchers found that patients infected with invasive aspergillosis who were treated with voriconazole responded better to treatment than those treated with amphotericin B (2002;347:408).

Dr Raoul Herbrecht, Hopital de Hautepierre, Strasbourg, and colleagues randomly assigned 391 immunocompromised patients to receive either intravenous voriconazole, two doses of 6mg/kg body weight on day one, 4mg twice daily for at least seven days followed by 200mg orally twice daily, or intravenous amphotericin B deoxycholate 1mg–5mg/kg daily. Patients with an intolerance or no response to the initial therapy could be switched to other licensed antifungal therapy and continued to be included in the analysis. The median duration of treatment was 77 days (range two to 84) for voriconazole and 10 days (range one to 84) for amphotericin B. Of the 144 patients who received at least one dose of voriconazole, complete responses were seen in 20.8 per cent of patients and partial responses in 31.9 per cent at week 12. Of the 133 patients who received at least one dose of amphotericin B, complete responses were seen in 16.5 per cent and partial responses in 15.0 per cent.

The researchers comment that the superiority of voriconazole was not as a result of excessive interruptions in therapy or insufficient doses of amphotericin B and that duration of treatment is unlikely to be the only factor contributing to better overall results with voriconazole. The survival rate of patients at week 12 was also greater in the voriconazole group — 70.8 per cent compared with 57.9 per cent of patients treated with amphotericin B.

The researchers add that voriconazole was better tolerated than amphotericin B, with fewer drug-related adverse events.