Using Vfend (voriconazole) for the treatment of nonneutropenic patients with candidemia, an often-fatal hospital-acquired bloodstream infection, is as effective as a regimen of two older antifungals and carries fewer serious side effects than that regimen.
This is based on a study published in The Lancet in October.
The study highlights Vfend, Pfizer's antifungal treatment, as an important treatment option for candidemia in nonneutropenic patients (those who do not have low white blood cell counts). Vfend is the only treatment available in oral and IV formulations that is approved as first-line therapy against both mould and yeast infections.
"This study proves the effectiveness of Vfend for the treatment of candidemia, an often-deadly fungal infection for which we need multiple treatment options," said Dr. Jack D. Sobel, study investigator and professor and chief of the Division of Infectious Diseases at Wayne State University School of Medicine. "Because of Vfend's broad spectrum of activity against infections caused by yeasts and moulds, it is a good first-choice treatment option for immunocompromised patients who are at risk for those types of infection."
Candidemia is a systemic fungal infection in the blood that can lead to other body organ infections. Surgical patients and patients with compromised immune systems are at high risk for candidemia.
This study was the first ever to compare Vfend versus amphotericin B followed by fluconazole, both of which are approved treatments for candidemia. However, amphotericin B is commonly associated with toxic effects, including a risk of kidney failure. In addition, the prevalence of fluconazole-resistant Candida is increasing.
The study used a non-inferiority study design in which the trial objective was to evaluate the comparability of differing treatment options. Results showed that the treatment regimens were comparable in terms of effectiveness, including time required to clear Candida from the blood. Investigators concluded that Vfend is an effective alternative to this regimen and that it is among the most useful treatment options for candidemia in non-neutropenic patients due to its efficacy, tolerability and broad spectrum, and also due to the availability of IV and oral formulations.
Treatment discontinuations due to all-cause adverse events were more frequent in the Vfend group, although most discontinuations in this group were due to non-drug-related events. Patients taking Vfend experienced fewer serious adverse events, such as renal toxicity.
The study included 370 patients who had at least one positive blood culture for Candida within 96 hours of entering the study, and who did not suffer from neutropenia. Patients were randomly assigned (in a 2-to-1 ratio) to receive either Vfend or amphotericin B followed by fluconazole.