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A Randomized, Blinded, Multicenter Trial of Lipid-Associated Amphotericin B Alone versus in Combination with an Antibody-Based Inhibitor of Heat Shock Protein 90 in Patients with Invasive Candidiasis

Pachl, Jan ; Svoboda, Petr ; Jacobs, Frédérique ; Vandewoude, Koenraad ; van der Hoven, Ben ; Spronk, Peter ; Masterson, Gary ; Malbrain, Manu ; Aoun, Mickael ; Garbino, Jorge ; Takala, Jukka ; Drgona, Lubos ; Burnie, James ; Matthews, Ruth

In: Clinical Infectious Diseases, 2006, vol. 42, no. 10, p. 1404-1413

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    Title
    • A Randomized, Blinded, Multicenter Trial of Lipid-Associated Amphotericin B Alone versus in Combination with an Antibody-Based Inhibitor of Heat Shock Protein 90 in Patients with Invasive Candidiasis
    Author
    • Pachl, Jan. Charles University, Prague
    • Svoboda, Petr. Research Centre for Traumatology and Surgery, Brno, Czech Republic
    • Jacobs, Frédérique. Erasme Hospital, Brussels
    • Vandewoude, Koenraad. Ghent University Hospital, Ghent, Belgium
    • van der Hoven, Ben. Erasmus University Medical Center, Rotterdam
    • Spronk, Peter. Gelre Hospitals, Apeldoorn, The Netherlands
    • Masterson, Gary. University of Liverpool, Liverpool
    • Malbrain, Manu. ZiekenhuisNetwerk Antwerpen Campus Stuivenberg, Antwerp
    • Aoun, Mickael. Jules Bordet Institute, Brussels
    • Garbino, Jorge. University Hospital, Geneva
    • Takala, Jukka. University Hospital, Bern, Switzerland
    • Drgona, Lubos. National Cancer Institute, Bratislava, Slovak Republic
    • Burnie, James. University of Manchester, Manchester, United Kingdom
    • Matthews, Ruth. University of Manchester, Manchester, United Kingdom
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Clinical Infectious Diseases, 2006, vol. 42, no. 10, p. 1404-1413. The University of Chicago Press
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:290257
    Summary
    Background. Mycograb (NeuTec Pharma) is a human recombinant monoclonal antibody against heat shock protein 90 that, in laboratory studies, was revealed to have synergy with amphotericin B against a broad spectrum of Candida species. Methods. A double-blind, randomized study was conducted to determine whether lipid-associated amphotericin B plus Mycograb was superior to amphotericin B plus placebo in patients with culture-confirmed invasive candidiasis. Patients received a lipid-associated formulation of amphotericin B plus a 5-day course of Mycograb or placebo, having been stratified on the basis of Candida species (Candida albicans vs. non-albicans species of Candida). Inclusion criteria included clinical evidence of active infection at trial entry plus growth of Candida species on culture of a specimen from a clinically significant site within 3 days after initiation of study treatment. The primary efficacy variable was overall response to treatment (clinical and mycological resolution) by day 10. Results. Of the 139 patients enrolled from Europe and the United States, 117 were included in the modified intention-to-treat population. A complete overall response by day 10 was obtained for 29 (48%) of 61 patients in the amphotericin B group, compared with 47 (84%) of 56 patients in the Mycograb combination therapy group (odds ratio [OR], 5.8; 95% confidence interval [CI], 2.41-13.79; P < .001). The following efficacy criteria were also met: clinical response (52% vs. 86%; OR, 5.4; 95% CI, 2.21-13.39; P < .001), mycological response (54% vs. 89%; OR, 7.1; 95% CI, 2.64-18.94; P < .001), Candida-attributable mortality (18% vs. 4%; OR, 0.2; 95% CI, 0.04-0.80; P = .025), and rate of culture-confirmed clearance of the infection (hazard ratio, 2.3; 95% CI, 1.4-3.8; P = .001). Mycograb was well tolerated. Conclusions. Mycograb plus lipid-associated amphotericin B produced significant clinical and culture-confirmed improvement in outcome for patients with invasive candidiasis