DTB gives cautious welcome to second-line use of two newer antifungal agents ...
Voriconazole (Vfend), a new triazole antifungal agent, is a reasonable choice for second-line treatment against systemic fungal infections,
according to the Drug and Therapeutics Bulletin (2004;42:5).
However, the DTB is not convinced by the claim that this drug
is superior to amphotericin B at increasing survival rates in patients
with invasive aspergillosis.
The January issue of the bulletin also considers the place of caspofungin
(Cancidas), a new echinocandin antifungal that has activity against Candida and Aspergillus spp. While the DTB acknowledges that this drug is better
tolerated than conventional amphotericin B it suggests there is little
evidence to justify its use, “except possibly as a second-line
treatment in patients with life-threatening invasive candidiasis”.
The DTB concludes: “Neither caspofungin nor voriconazole should
be used for empirical treatment of fever in patients with neutropenia.”
... but criticises transdermal contraceptive patch website
Evra, the new contraceptive patch, is twice as likely to be discontinued
because of unwanted effects as the combined oral contraceptive, according
to the Drugs and Therapeutics Bulletin (2003;41:89). It has also criticised
the way Janssen-Cilag has promoted the product on a specially designed
website.
Joe Collier, editor of DTB said: “Evra ... does not seem to offer
compelling clinical advantages over standard oral contraceptives and
is much more expensive. What is more, there is no convincing evidence
to back up the promotional claim improperly made to patients that Evra
is just as effective as the contraceptive pill.”
In response, a spokeswoman for Janssen-Cilag, told The Journal: “There
have been two head-to-head studies comparing Evra with an oral contraceptive
pill and neither study has shown a significant difference in efficacy.
In a US survey of 8,000 women, nine out of 10 Evra users said they preferred
Evra to their previous method of birth control, and three million women
worldwide are using Evra.”
She explained that the website referred to by the DTB is only intended
for use by women who have already been prescribed the patch, and requires
the product licence number to be entered to log on.
Other DTB topics The December and January issues of DTB review
the management of bronchiectasis and the use of performance-enhancing
drugs, respectively (2003;41:91 and 2004;42:1).
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