Fungal infections: From specialty area to expanded population

According to new research from Datamonitor, out of nine million patients at-risk, 1.2 million will go on to develop fungal infections. The treatment of invasive fungal infections is therefore expected to change from a specialty area, focused on specific subpopulations, to an increasingly high volume practice targeting large numbers of hospitalized and community based immunocompromised individuals.

In the report 'Stakeholder Insight: Invasive Fungal Infections', Datamonitor assesses the total patient population at risk of acquiring an invasive fungal infection, and the factors which contribute to this increased risk. The research also looks into prescription decisions, including detailed product profiles and usage trends of the main systemic antifungal product currently available.

Growing incidence

Although relatively rare, the overall incidence of invasive fungal infections has increased rapidly over the past 20 years. Historically, these infections were considered a specialty area affecting specific subpopulations only. However, with increasing numbers of immunocompromised patients, such as those undergoing chemotherapy, transplantation and suffering with HIV/AIDS or diabetes mellitus, the need for potent and safe antifungal agents is likely to increase, especially as part of longer-term therapy.

Within the five major risk groups; cancer patients, HIV/AIDS patients, transplant patients, surgery and neonates, patients undergoing surgery are by far the largest, forming approximately 50% of the total. Research also reveals that leukemic patients followed by HIV/AIDS patients, account for the highest percentage of actual fungal infections in hospitals (in the US, Japan, France, Germany, Italy, Spain and the UK) with 20% and 17%, respectively.

Surgical dangers

Surgery increases the opportunity for fungal infections to enter the body, with a prolonged hospital stay and invasive devices increasing this risk further. Research has revealed that patients undergoing procedures involving the abdomen, gastrointestinal tract, or cardiovascular surgery are at the highest risk from a fungal infection. Although there is no 'acceptable' mortality rate, for a serious infection, {such as aspergillosis}, this is likely to be between 50-90%, although this varies considerably among different infections.

The treatment of invasive fungal infections is changing from a specialty area, focused on specific subpopulations, to an increasingly high volume practice targeting large numbers of hospitalized and community based patients, such as those undergoing chemotherapy, transplantation and suffering with HIV/AIDS or diabetes mellitus.

Improving the standard of therapy in this area is made more difficult by the enormous variability in patient risk factors and treatment response rates. A lack of consensus regarding outcome also prevents clear recommendations as to the optimum type and duration of antifungal therapy. Despite this, Datamonitor research reveals a significant level of antifungal prophylaxis, approximately 23% of the total 'at risk' group, which appears varied across patient type and country, with differing success rates;

Novel products in development

While Diflucan and Sporanox are the most popular prophylactic therapies on a global basis, physicians in the US are prescribing newer therapies that are more expensive. Examples include Abelcet (Elan/Enzon) or Cancidas (Merck) at 5% and 4% of patients respectively.

Other factors, such as dosing schedule and oral availability, are also important in the antifungal prophylaxis choice. Most patients on prophylactic therapy tend to be based in the community or are discharged from the hospital while still being treated. As such, the availability of an oral equivalent is a necessity for consideration of a product in a prophylactic regime.

In addition, a product with a lower dosing frequency will be preferred since this facilitates patient compliance. Consequently, the oral availability of Diflucan and Sporanox in low dose formulations has also contributed to these products being the preferred options for prophylaxis.

The market is now awaiting the launch of the second-generation azole, posaconazole, from Schering-Plough Corporation. The drug, provisionally called Noxafil, is currently in phase III trials and is being developed for oral use, in suspension and tablet forms. Schering-Plough has already released a series of clinical data in support of the drug, in anticipation of an NDA submission in the first half of 2004.

If you found this week's Expert View useful, you may be interested in these reports:

• Stakeholder Insight: Invasive Fungal Infections - Options Outweigh Replacements

• Stakeholder Insight: The Hospital Antibacterial Market - Specialist Products Drive Market Growth

• Superficial Fungal Infections. Brand Awareness - the key to success?

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