Voriconazole study design limits benefits found
Voriconazole (Vfend) is a “modest addition” to treatments for candidaemia, according to the author of a comment piece published in The
Lancet last week (2005;366:1413).
John Graybill’s comments accompany a study that examined the effects
of voriconazole against those of sequential therapy with amphotericin
B and fluconazole. The study’s authors found that voriconazole
was as effective as the comparator regimen and had fewer toxic effects.
They conclude that voriconazole provides “an important new treatment
option” for candidaemia (ibid, p1435). However, Dr Graybill, from
the University of Texas Health Science Centre, San Antonio, says that
the relevance of the control group and the endpoints chosen mean that
the findings should be viewed more modestly.
He points out that caspofungin is displacing amphotericin B as the drug
of choice for seriously ill patients with candidaemia. “We do not
yet know how voriconazole would compare against an echinocandin,” he
comments.
He also questions the 12-week time frame used in the study, arguing that
clinicians would not wait three months to decide whether patients with
candidaemia had responded to treatment. |
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