State health officials say there’ve been more than 7,000 confirmed and probable cases of Valley fever so far this year. That number was close to 12,000 last year.
A new study published in the journal Annals of Internal Medicine finds a new medication is proving to be effective in treating patients with one type of Valley fever called disseminated coccidioidomycosis.
John Galgiani, director of the Valley Fever Center for Excellence at the University of Arizona, joined The Show to talk more about it.
Full conversation
MARK BRODIE: John, who are these patients and what does this treatment look like?
JOHN GALGIANI: Sure. So there’s this new drug, not yet approved by the FDA, called Olorofim. And it actually has a spectrum of activity against a number of different exotic fungi, but it also has activity against the fungus that causes Valley fever. And the first study done with this was an international study, but here in Arizona and other places where cocci is a common disease, we used it for those patients.
And the patients to get into that study had to really be failing everything else that was available. It was essentially a salvage study. So there’s no randomized control here. It was simply people that weren’t doing well at everything we had available on the market already, and they were enrolled in this study.
And when we looked at the subset, and this is really work done by Dr. Fariba Donovan as the lead author on this multicenter study, she found and her colleagues with her found that these patients actually stabilized or in general got better on this treatment.
Now, it’s problematic because there was no comparison group, and so you have trouble. This is over time. There’s a lot of reasons to have trouble being sure what that means, but in fact, the patients got better on that treatment, really suggesting that it deserved more treatment trials than it had already.
MARK BRODIE: So do you consider this promising then as a treatment for at least for some Valley fever patients?
JOHN GALGIANI: Yes. ... The treatments we have today are not curative. Nothing cures this disease. Some of them help and they put the fungus to sleep, but that if the immune system doesn’t keep it under control, it comes back when you stop the drugs. So that people with cocci meningitis, for example, we recommend no matter how well you do to never stop treatment for the rest of your life.
So any new drugs have the potential that it can do better than that. And so we think that this drug, some of the preliminary data suggest it has that potential. We don’t know that yet. But that’s a possibility. But even if it was not any better, having another drug with an entirely different mechanism of action just expands the spectrum of options available to a clinician.
MARK BRODIE: So is it fair to say that one of the things that you are looking for next is to see how this drug would work on patients compared to a control group?
JOHN GALGIANI: Yes. Valley fever meningitis, it’s a special case because we have very strong historical evidence that if you aren’t treated at all, and we know that because there were no treatments till the 1960s, without treatment, it’s a lethal infection. So if you have a drug that gets people surviving, I think you don’t need a comparison group.
But for all the rest of the forms of Valley fever, it’s a little bit variable. So you would want to compare it. Now you wouldn’t the patients that have serious disease, you wouldn’t be able to do a placebo control, but you’d do some sort of a randomization where they’d either get olorofim, or whatever the new drug is, and compare it to standard therapy.
MARK BRODIE: So we’re talking about patients in studies who have been diagnosed with Valley fever. I know that the diagnosis is often sort of a challenge in and of itself. Where are we in terms of accurate and reliable testing for Valley fever?
JOHN GALGIANI: Well, for the most serious form, which fortunately is only a small percentage of patients, it’s pretty obvious. Those people may have delays, and they often do have delays, but eventually they get diagnosed because they have such damage to their bodies.
But for most people, they don’t have that kind of progressive infection. And for those patients, we do a very, very bad job of finding it. Some of those patients may never really have a serious illness, may not seek medical care, either because they can’t, because they can’t get off work, for example, or don’t have any money, or because they aren’t sick enough.
But for most people who seek care, there’s a huge delay in diagnosis, if they get diagnosed at all. In fact, there’s CDC information now that shows an average delay of 30 days for most people who get diagnosed with Valley fever and at a cost of $175 per day. So we could change that simply by having doctors doing more tests. And I think to get that to happen, it probably also means raising the awareness of everybody who lives here where this disease is so common.
MARK BRODIE: But I would imagine also that 30 days isn’t going to cut it, right? Like you go to the clinic for a flu test or a COVID test or a strep test, you know the result before you leave the exam room.
JOHN GALGIANI: That’s right. And unfortunately, the tests we have today are tests that go to a referral clinic. And so you don’t get the results back for two days at the fastest, and often much longer time lags. We’d love to have point-of-care tests, and there’s work being done in that direction as well.
MARK BRODIE: Is there also work on trying to figure out for folks who maybe are asymptomatic, because a lot of folks who have Valley fever never see symptoms. Like, is there a way to tell if you have been infected at some point in your life?
JOHN GALGIANI: Yes. We’ve actually for many years were doing skin tests for Valley fever. There is a test now available again, but in fact, it’s kind of cumbersome and is not being used very widely, and also has frequently some false negatives.
But we’ve been working on a test at the University of Arizona where we measure blood cells from a blood draw, simple blood draw, and we can find lymphocytes that show that we have memory to a past infection. And that is really a useful test. So we could do this without injecting something into your skin and tell you whether or not you whether you knew it or not had had Valley fever in the past.
And that would be really useful if you then need to have some sort of a therapy, for example, which is going to suppress your immune system, and it might inform whether or not that suppressive therapy is going to be risky to you or whether you can do it without any problem. So that’s a thing. And plus, with this test to tell whether or not you’ve had Valley fever in the past, we can use that to actually calculate what the risk is on average annually of getting Valley fever. And that’s very valuable to help with vaccine sample size estimate for doing the clinical trials to see if a vaccine works.
MARK BRODIE: So one of the things that every time you and I talk, you bring up this issue of awareness. You brought it up a little bit ago. What are you trying to do now? Like, you’ve been sort of beating this drum for years and years and years now, trying to tell people about Valley fever and teach patient, potential patients and physicians about Valley fever. Like, are those efforts working?
JOHN GALGIANI: They’re working in some places, but there’s a lot more to do. It’s not, unfortunately, widespread. And that’s I think partly because people who live here are not aware as they should be about this disease. I think that awareness of Valley fever is your best defense. There’s really no way to prevent inhaling a spore.
So knowing about it is probably the best single thing we can do. And I think for people to know about it, they’re going to start asking their doctors, "Don’t you think you should test me for Valley fever?" when they should be. And I think that’ll I think the medical community will respond and start doing it. I think it should be done a lot more frequently, even if you get a number of negatives. That’s better than missing that one positive a few times. So I’m fully in support of that.
MARK BRODIE: All right, John Galgiani, thanks so much. I really appreciate it.
JOHN GALGIANI: Sure.
MARK BRODIE: John Galgiani is director of the Valley Fever Center for Excellence at the University of Arizona.
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