[en] The IA-DUET study aimed to compare azole-echinocandin combination with azole monotherapy for invasive aspergillosis. Recruitment was hindered by patient ineligibility, competing studies, and guidelines favoring combination therapy when azole resistance was unknown. The low IA-attributable mortality suggests future trials may benefit from cluster randomization or composite endpoints to enhance efficiency.
Disciplines :
Hematology
Author, co-author :
Lamberink, Hanne ; Department of Internal Medicine, Section of Infectious Diseases and department of Medical Microbiology, Erasmus University Medical Center, Rotterdam, The Netherlands
Huygens, Sammy ; Department of Internal Medicine, Section of Infectious Diseases and department of Medical Microbiology, Erasmus University Medical Center, Rotterdam, The Netherlands ; Department of Hematology, Ghent University Hospital, Ghent, Belgium
Aerts, Robina ; Department of Hematology, University Hospitals Leuven, Leuven, Belgium ; Department of Microbiology, Immunology and transplantation, KU Leuven, Leuven, Belgium
Lagrou, Katrien ; Department of Microbiology, Immunology and transplantation, KU Leuven, Leuven, Belgium ; Department of Laboratory Medicine and National Reference Center for Mycosis, Excellence Center for Medical Mycology (ECMM), University Hospitals Leuven, Leuven, Belgium
van Leeuwen-Segarceanu, Elena; Department of Internal Medicine, St. Antonius Hospital Nieuwegein, The Netherlands
Lodewyck, Tom ; Department of Hematology, AZ St-Jan Brugge-Oostende Hospital, Bruges, Belgium
Nieuwenhuizen, Laurens ; Department of Hematology, Maxima Medical Center, Eindhoven/Veldhoven, The Netherlands
Corsten, Maarten F ; Department of Hematology, Meander Medical Center, Amersfoort, The Netherlands
Moors, Ine ; Department of Hematology, Ghent University Hospital, Ghent, Belgium
Servais, Sophie ; Université de Liège - ULiège > Département des sciences cliniques
De Greef, Julien ; Department of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
Hites, Maya ; Clinic of Infectious Diseases, Hôpital Universitaire de Bruxelles, Brussels, Belgium
Demandt, Astrid ; Division of Hematology, Department of Internal Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
Schauwvlieghe, Alexander ; Department of Hematology, AZ St-Jan Brugge-Oostende Hospital, Bruges, Belgium
Maertens, Johan; Department of Hematology, University Hospitals Leuven, Leuven, Belgium
Rijnders, Bart ; Department of Internal Medicine, Section of Infectious Diseases and department of Medical Microbiology, Erasmus University Medical Center, Rotterdam, The Netherlands
van de Peppel RJ, Visser LG, Dekkers OM, de Boer MGJ. The burden of invasive aspergillosis in patients with haematological malignancy: a meta-analysis and systematic review. J Infect 2018; 76:550-62.
Petraitis V, Petraitiene R, Sarafandi AA, et al. Combination therapy in treatment of experimental pulmonary aspergillosis: synergistic interaction between an antifungal triazole and an echinocandin. J Infect Dis 2003; 187:1834-43.
Marr KA, Schlamm HT, Herbrecht R, et al. Combination antifungal therapy for invasive aspergillosis: a randomized trial. Ann Intern Med 2015; 162: 81-9.
Morrissey CO, Kim HY, Duong TN, et al. Aspergillus fumigatus—a systematic review to inform the World Health Organization priority list of fungal pathogens. Med Mycol 2024; 62:myad129.
Lestrade PP, Bentvelsen RG, Schauwvlieghe AFAD, et al. Voriconazole resistance and mortality in invasive aspergillosis: a multicenter retrospective cohort study. Clin Infect Dis 2019; 68:1463-71.
van der Linden JW, Snelders E, Kampinga GA, et al. Clinical implications of azole resistance in Aspergillus fumigatus, The Netherlands, 2007-2009. Emerg Infect Dis 2011; 17:1846-54.
Verweij PE, Rijnders BJA, Brüggemann RJM, et al. Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion. Intensive Care Med 2020; 46:1524-35.
Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71:1367-76.
van de Peppel RJ, van Grootveld R, Hendriks BJC, et al. Implementation of a clinical decision rule for selecting empiric treatment for invasive aspergillosis in a setting with high triazole resistance. Med Mycol 2021; 60:myab060.
Slobbe L, Polinder S, Doorduijn JK, et al. Outcome and medical costs of patients with invasive aspergillosis and acute myelogenous leukemia-myelodysplastic syndrome treated with intensive chemotherapy: an observational study. Clin Infect Dis 2008; 47:1507-12.
Dutch Working Party on Antibiotic Policy. SWAB guidelines for the management of invasive fungal infections. 2017. Available at: https://swab.nl/nl/exec/file/download/86. Accessed 5 May 2024.
Walsh TJ. Meeting the therapeutic challenges of emergent and rare invasive fungal diseases through novel clinical trial designs. Open Forum Infect Dis 2024; 11:ofae257.
