This article is part of the supplement: 28th International Symposium on Intensive Care and Emergency Medicine
Combination therapy with efungumab for the treatment of invasive Candida infections: several illustrative case reports
1 Gelre Hospitals (Lukas Site), Apeldoorn, The Netherlands
2 Erasmus Hospital, Rotterdam, The Netherlands
3 Birmingham University Children's Hospital, Birmingham, UK
4 Free University of Brussels, Belgium
5 University Hospital Brno, Czech Republic
6 Christie Hospital, Manchester, UK
7 Central Manchester & Manchester Children's University Hospitals, Manchester, UK
Critical Care 2008, 12(Suppl 2):P20 doi:10.1186/cc6241
The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/12/S2/P20
| Published: | 13 March 2008 |
© 2008 BioMed Central Ltd
Introduction
Efungumab (Mycograb®) is a human recombinant antibody against fungal Hsp90 that, in combination with lipid-associated amphotericin B, has shown efficacy in patients with invasive candidiasis (phase 3 data). Eight compassionate-use case studies of efungumab in combination with antifungal agents in the treatment of invasive Candida infections are presented.
Methods
Efungumab was given to eight patients at 1 mg/kg twice daily, typically for 5 days combined with standard doses of amphotericin B, caspofungin, flucytosine or fluconazole. Patients were 7–69 years old with culture-confirmed invasive fungal infections, from which Candida spp. (Candida albicans, Candida krusei, Candida glabrata) were isolated; five patients had candidal peritonitis, one candidaemia, one a subphrenic abscess and candidaemia, and one mediastinal, pleural and pulmonary candidiasis; one patient had neutropenia.
Results
Seven out of eight patients responded to 10 doses of efungumab; one patient (a child with candida peritonitis and abdominal abscesses associated with a non-Hodgkin's abdominal lymphoma) responded but relapsed and required a second course of treatment, to which he responded. One patient, with mediastinal, pulmonary and pleural candidiasis associated with ARDS, was withdrawn after two doses of efungumab, due to blood pressure fluctuations, impaired gas exchange, increased cardiac output and fever; in this patient the efungumab was not prefiltered. Three further patients experienced transient hypotensive or hypertensive episodes after the first dose, which did not recur with subsequent doses. One patient experienced nausea and vomiting after the second dose.
Conclusion
This experience with efungumab extends the clinical trial database. It shows efficacy in poor-prognosis patients who failed to respond to conventional monotherapy (6–20 days), in patients with multiple species of Candida, and in candidaemia in a neutropenic patient. All but one patient tolerated efungumab and seven patients completed the course without major side effects.