A new foundation - The Global Action Fund for Fighting Fungal Infections or GAFFI was launched in London, New York and Sao Paulo on November 6th. An international organisation, GAFFI will highlight the plight of 300 million people worldwide and start to reverse unnecessary deaths and suffering.
Fungal infections kill at least 1,350,000 patients with or following AIDS, cancer, TB and asthma as well as causing untold misery and blindness to tens of millions more worldwide. Yet its symptoms are mostly hidden and occur as a consequence of other health problems. The tragedy is that many of the best drugs for treating fungal infections have been available for almost 50 years.
GAFFI was officially launched by actor Rupert Everett who has pledged to help GAFFI raise awareness of the problems. Katie Melua endorsed GAFFI and allowed GAFFI to produce a moving video to her hit song "I'd love to kill you with a Kiss". Professor Denning, GAFFI's President stated at the London launch in the House of Commons: "This is a global plague on an unappreciated scale. Whilst the World Health Organisation has just developed clinical guidelines for doctors for fungal meningitis in AIDS; other critical fungal infections are ignored. The lack of basic fungal diagnostic capability and unavailable treatments in many countries results in millions of avoidable deaths and illness. GAFFI is here to change this dismal situation.” more
WMA adopts statement on fungal disease diagnosis and management
At their 64th General Assembly in Brazil, the World Medical Association adopted a statement on Fungal Disease Diagnosis and Management. The statement reads: “The WMA stresses the need to support the diagnosis and management of fungal diseases and urges national governments to ensure that both diagnostic tests and antifungal therapies are available for their populations...
The WMA encourages its members to undertake and support epidemiologic studies on the burden of fungal disease in their country and to inform the national government of the results". more
Impact on quality of life of recurrent thrush
Recurrent vulvovaginal candidiasis (rVVC) is a chronic condition causing pain and much discomfort. In an international study, Samuel Aballéa and colleagues of the Université of Lyon describe the numerous depression and anxiety problems suffered by women with rVVC. An online survey of women reporting rVVC using the EQ-5D and SF-36 questionnaires was done in France, Germany, Italy, Spain, UK and the USA. Of 12,834 women previously identified with VVC, 620 women with rVVC were studied. The quality of life scores were compared among those with current symptoms to assess the direct impact of a VVC attack, and the whole group compared with peers without rVVC.
During an acute episode of VVC, 68% of women reported depression/anxiety problems, and 54% between episodes, compared to less than 20% in general population (p < 0.001). All SF-36 domain scores in those with rVVC were significantly below general population norms. Mental health domains were the most affected. The difference was largest in Italy, where 60% reported anxiety/depression problems outside episodes vs. 9.3% in the general population. The impact on productivity was estimated at 33 lost work hours per year on average, corresponding to estimated costs between €266/year and €1,130/year depending on the country.
The average index score in women with rVVC is comparable to other diseases such as asthma or COPD and worse than diseases such as headache/migraine according to US and UK catalogues of index scores. There was a high level of consistency across countries. View report
Liver failure is often complicated by fatal invasive aspergillosis (IA)
Of nearly 800 patients with acute-on-chronic liver failure (ACLF), around 5% developed invasive pulmonary aspergillosis (IPA) with almost 95% of them, going on to die despite antifungal treatment. Jiajia Chen et al (Zhejiang University, Hangzhou, China) note that most deaths were due to progression of IPA, the remainder due to the progression of liver failure. Only two patients survived on antifungal treatment. Survival was only achieved in patients who were able to take antifungal drugs for more than 5 days.
90% of the patients who developed IPA were also prescribed corticosteroids, and these patients had worse survival (p = <0.01). Age and hepatic encephalopathy were also significant for increased mortality (p = 0.021 and p = 0.001). Until recently there was no analysis of the risk factors for IPA in patients with ACLF, with most prior emphasis being on transplantation and chemotherapy patients.
Isavuconazole phase III trial demonstrates non inferiority vs voriconazole
Astellas who developed the new antifungal drug isavuconazole, have published results from their phase III trials on the treatment of invasive aspergillosis, indicating favourable data for isavuconazole in comparison to voriconazole link ."The randomized, double-blind isavuconazole study achieved its primary objective in demonstrating non-inferiority versus voriconazole for the primary treatment of invasive fungal disease caused by Aspergillus species or certain other filamentous fungi. Isavuconazole was effective as determined by the primary endpoint of all-cause mortality through day 42 in the intent-to-treat population (N=516). The all-cause-mortality was 18.6% in the isavuconazole treatment group and 20.2% in the voriconazole group". In the sample of 500 patients there was a 7% lower mortality and only 40% drug related adverse events with isavuconazole, compared to 60% drug-related adverse events for voriconazole. The isavuconazole is given once daily( IV or oral) compared to twice daily for voriconazole.
Basilea announced on Dec 3rd that the U.S. Food and Drug Administration (FDA) designated isavuconazole as a Qualified Infectious Disease Product (QIDP) for the treatment of invasive aspergillosis.. QIDP status provides priority review and a five-year extension of market exclusivity following product approval in the United States. Info
Isavuconazole also received orphan drug designation for the treatment of zygomycosis, a life-threatening invasive fungal infection (IFI) caused by emerging molds.
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