Medical Costs Analysis for Antifungal Prophylaxis in Neutropenic Patients with Hematological Malignancies: A Systematic Review Analysis.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3334-3334
Author(s):  
Takamichi Shintani ◽  
Osamu Imataki ◽  
Hiroaki Ohnishi ◽  
Akira Kitanaka ◽  
Yoshitsugu Kubota ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Antifungal Agent ◽  
Hematological Malignancies ◽  
Antifungal Agents ◽  
Single Agent ◽  
Medical Costs ◽  
Antifungal Prophylaxis ◽  
Candida Spp ◽  
Expected Cost ◽  
Neutropenic Patients

Abstract Purpose Invasive fungal infection (IFI) is one of the leading causes of mortality and morbidity in neutropenic patients with hematological malignancies (HM). Randomized studies and followed by metanalysis suggest the prophylactic effects of antifungal agents for chemotherapy-induced neutropenia. The purpose of this study is to estimate the medical costs on each antifungal agent for prophylaxis of antifungal infection in neutropenic patients in Japan. Method PubMed was searched for articles, which reported antifungal prophylaxis in neutropenic patients with HM, published after 1999, using 3 keywords; ’prophylaxis ’, ’hematological malignancy’ and ’fungal infection’. Fifteen articles that met the criteria were selected; randomized controlled trial, more than 100 cases overall, prospective study, and single agent used in each study arm. Antifungal agents were limited to the 4 drugs; fluconazole (FLCZ) capsules or tablets, itraconazole (ITCZ) capsules or oral solution, micafungin (MCFG), and liposomal amphotericin B (L-AMB). We assumed 3-week-prophylaxis after chemotherapy and 2-week-target therapy for the occurrence of the breakthrough infection, and designed the decision tree models in which a breakthrough fungal infection occurred in certain incidence of proven and probable IFI. The incidences of IFI from the 15 studies were applied to our model. MCFG, voriconazole (VRCZ) and L-AMB were applied as target therapies to the assumed Candida spp., Aspergillus spp., and other fungal infections, respectively. An average expected cost for prophylaxis on each antifungal agent was calculated and compared. Sensitive analysis was performed for the parameter of the incidence of breakthrough IFI. Results In each prophylaxis agent, the collected study population was 1061 cases in FLCZ, 1510 in ITCZ, 425 in MCFG, and 219 in L-AMB. The incidence of proven and probable IFI was 4.3% (46/1061) in FLCZ, 2.7% (41/1510) in ITCZ, 1.6% (7/425) in MCFG, and 3.7% (8/219) in L-AMB. Causative fungi were revealed in table 1 below. The mean duration to the breakthrough fungal infection was 20 days (95CI, 13–26) after chemotherapy. The average expected cost for prophylaxis in each drug was $1,098 for FLCZ, $532 for ITCZ, $1,313 for MCFG, and $2297 for L-AMB. Conclusion In our review, the prophylactic failure seems be comparable in the 4 antifungal agents. However, cost-effectiveness was the superior in the prophylaxis by ITCZ than the other agents in neutropenic patients with HM in Japan. The incidence of proven and probable IFI and its causes. Agents for prophylaxis Proven and probable IFI Prophylactic success (%) (95% CI) Candida spp. (%) Aspergillus spp. (%) Other fungus (%) Number of the causative fungus is indicated as the proportion among prophylactic failure cases. FLCZ 4.3% (46/1061) 95.7 (94.3–96.7) 23.7 63.2 13.2 ITCZ 2.7% (41/1510) 97.3 (96.3–98.0) 23.5 58.8 17.6 MCFG 1.6% (7/425) 98.4 (96.6–99.2) 57.1 14.3 28.6 L-AMB 3.7% (8/219) 96.3 (93.0–98.1) 75.0 25.0 0.0

Efficacy and Safety of Micafungin as An Empirical Antifungal Agent for Febrile Neutropenic Patients with Hematological Diseases.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4661-4661
Author(s):  
Joon Seong Park ◽  
Dong Hwan Kim ◽  
Chul Won Choi ◽  
Seong Hyun Jeong ◽  
Jin-Hyuk Choi ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Success Rate ◽  
Antifungal Agent ◽  
Conflicts Of Interest ◽  
Multicenter Trial ◽  
Base Line ◽  
Efficacy And Safety ◽  
Hematological Disorders ◽  
Neutropenic Patients ◽  
Grade 3

Abstract Abstract 4661 Introduction Invasive or possible fungal infection is often fatal and its incidence is increasing in febrile neutropenic patients with hematological malignancies. Thus, empirical antifungal agent should be carefully selected for those patients. Patients and Methods The study was conducted as a prospective multicenter trial to document the efficacy and safety of micafungin (Mycamine®), a class of echinocandin, as an empirical antifungal agent in febrile neutropenic patients. Micafungin was administrated for sustained fever (>38.4°C) on day 3 - 5 after initiation of empirical antibiotic therapy. The overall success rate according to the composite score (no breakthrough fungal infection, survival for seven days beyond the end of therapy, did not discontinue therapy prematurely, had resolution of fever during the period of neutropenia, and successfully treated a documented base-line fungal infection) and side effects were evaluated. Results A total of 47 patients with AML, ALL, MDS or lymphomas were enrolled. The overall success rate was 61.7% (29/47). Three patients (6.4 %) experienced grade 3/4 elevated aspartate aminotransferase and ten patients (21 %) showed grade 3/4 hyperbilirubinemia and nine of which resolved, and four patients died of septic shock. Patients with young age (< 50 yr) and ALL rather than AML showed a better response to micafungin. Less profoundly neutropenic (≥50 /mm3) patients revealed a better response, as did the patients who recovered from fever or neutropenia. Conclusions Micafungin has been reported to have an excellent efficacy (61.7 %) and safety profile when used as an empirical antifungal agent to treat febrile neutropenic patients with hematological disorders. Disclosures: No relevant conflicts of interest to declare.

Candidemia in Patients with Hematological Malignancies: The Role of Prophilaxis and the Importance of Local Epidemiology for Treatment

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4839-4839
Author(s):  
Mariana Bastos Oreiro ◽  
Miguel Canales ◽  
Julio García Rodríguez ◽  
Raquel de Paz ◽  
Ana Lopez de la Guia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hematological Malignancies ◽  
Combined Therapy ◽  
Venous Catheter ◽  
Clinical History ◽  
Antifungal Prophylaxis ◽  
Candida Spp ◽  
Non Hodgkin Lymphoma ◽  
Hospital Patients ◽  
Associated Risk Factors

Abstract Introduction: Candidemia is a serious condition with a high mortality rate in patients with hematological malignancies. It is thus important to understand the associated risk factors, as well as the need to establish adequate prophylaxis and early, effective therapy. The objective of this study was to determine the incidence of candidemia in hospital patients with hematological malignancies; to describe its clinical features and the risk factors associated with infection and with a poor outcome. Materials and methods: An electronic database was used to identify cases with a positive blood culture for Candida spp in patients with hematological malignancies admitted to the Hematology Ward of Hospital Universitario La Paz between January 2000 to March 2008. The clinical history of each identified case was reviewed. SPSS 15.0 was used for the statistical analysis. Univariant analysis was carried out using χ2. Results: Forty seven patients were identified, with an annual incidence of 1%. The species identified were Candida parapsilopsis in 46% of cases (n = 22) and Candida albicans in 21.3% (n = 10); the remainder was distributed amongst C. guillermondi, C. tropicalis and C. krusei. The underlying hemalogic malignancies were non-Hodgkin lymphoma (34%, n = 16), multiple myeloma (19%, n = 9) and acute myeloid leukemia (17%, n = 8). 48.9% of patients underwent stem cell transplantation (45.3% allogeneic and 54.7% autologous). No significant association was found between the underlying hemalogic malignancy and the species of Candida that was isolated. The antifungals used in treatment were liposomal amphotericin in 48.9% of cases, fluconazole in 12.7%, caspofungin in 4.2% and voriconazole in 4.2%, with combined therapy in 30% of patients. MIC50 and MIC90 for fluconazole against C. parapsilopsis were 4 and 32, respectively, and 0.03 and 8, respectively against C. albicans. MIC90 against the other species was 0.03. MIC50 and MIC90 for amphotericin were 0.03 and 1, respectively, against C. albicans, C. parapsilopsis and C. krusei. Voriconazole, itraconazole and caspofungin were found to have an MIC90 of 0.03 against all species of Candida. Thirty seven point eight percet of patients were already receiving antifungal prophylaxis at the time of diagnosis of candidemia, although 90% of cases of C. albicans candidemia were not on prophylaxis (p&lt;0.05). In terms of risk factors, 76.6% of patients had a central venous catheter, 78.8% were undergoing chemotherapy, 95.6% were receiving concomitant, broad-spectrum antibiotics, 21.7% were diabetic, 46.8% were receiving parenteral nutrition of which more than half (59.1%) were associated with C. parapsilopsis, 26.7% had a serious associated mucositis, 60.5% had less than 0.2 ×109/L neutrophils and 98% had less than 1.5 × 109/L neutrophils, 37% had kidney failure. Eight patients (17%) died as a result of candidemia: 4 from C. albicans, 2 from C. parapsilopsis, 1 from C. glabrata and 1 from C. krusei. Of the patients with C. albicans, 33% died, compared to 11.8% of those with other species of Candida (p&lt;0.05). Conclusion: Candida parapsilopsis was found to be the main causative species of candidemia in our centre, with a markedly high MIC50 and MIC90 for fluconazole, probably related to fluconazole prophylaxis. These findings highlight the importance of understanding the epidemiology of each centre when planning treatment and establishing an effective scheme of prophylaxis in high-risk patients to avoid the mortality associated with this type of infectious complication

Medical cost analysis for antifungal prophylaxis in neutropenic patients with hematological malignancies: a systematic simulation analysis

2010 ◽  
Vol 19 (10) ◽  
pp. 1657-1665 ◽  
Author(s):  
Osamu Imataki ◽  
Yoshitsugu Kubota ◽  
Hiroaki Ohnishi ◽  
Akira Kitanaka ◽  
Toshihiko Ishida ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Medical Cost ◽  
Hematological Malignancies ◽  
Simulation Analysis ◽  
Antifungal Prophylaxis ◽  
Neutropenic Patients

scholarly journals Treatment of candidemia caused by Candida albicans and Candida non - albicans in patients with hematological malignancies

2019 ◽  
Vol 91 (8) ◽  
pp. 84-92 ◽  
Author(s):  
G A Klyasova ◽  
A O Malchikova ◽  
K S Tandilova ◽  
E V Blohina ◽  
E N Parovichnikova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Culture ◽  
Hematological Malignancies ◽  
Antifungal Agents ◽  
Clinical Symptoms ◽  
Initial Therapy ◽  
Age Group ◽  
Candida Spp ◽  
Hematopoietic Stem ◽  
Causative Agents

Aim. To study the risk factors, symptoms and outcomes of candidemia caused by C. albicans and C. non - albicans in patients with hematological malignancies. Materials and methods. The study included patients with hematological malignancies and candidemia. The diagnosis of candidemia was established according to the single isolation of Candida spp. from blood culture and the presence of symptoms of infection. Results and discussion. Over 12 years (2006-2017), candidemia was diagnosed in 75 patients aged 17 to 77 years (median 48 years). The causative agents of candidemia were C. albicans in 34.7% of patients, C. non - albicans - in 65.3%. Candidemia caused by C. albicans prevailed in patients of the older age group (median 56.5 years, p=0.04) and in patients with lymphoma (61.5%, p=0.01) with colonization of the gut by the same species of Candida (88.5%, p=0.002). Isolation of C. non - albicans from blood culture was more common in patients with acute leukemia (51%, p=0.01) and in recipients of allogeneic hematopoietic stem cells (22.5%, p=0.01). The ability to form biofilms was observed more frequently among C. non - albicans (59.2%) than C. albicans (19.2%, p=0.001). The clinical symptoms of candidemia were non - specific (fever was in 97%). Septic shock developed in 25 (33%) patients with comparable frequency in both groups. Concomitant infections was also comparable (73% vs. 73.5%). Overall 30-day survival in patients with candidemia caused by C. albicans and C. non - albicans was 61.2% and 61.5%. Treatment with echinocandin was associated with increase of survival compared to other antifungal agents among patients with C. albicans candidaemia (88.9% versus 40%, p=0.02) and among C. non - albicans (77.3% versus 47.8%). Conclusion. C. non - albicans constituted a high proportion among causative agents of candidemia. High mortality rate was observed in both groups. Initial therapy with echinocandin was associated with increase of survival.

scholarly journals Inhibitory Effect of (-)-myrtenol alone and in combination with antifungal agents on Candida spp.

2021 ◽  
Vol 10 (15) ◽  
pp. e35101522434
Author(s):  
Bruno Bezerra Cavalcanti ◽  
Hermes Diniz Neto ◽  
Walicyranison Plinio da Silva-Rocha ◽  
Edeltrudes de Oliveira Lima ◽  
José Maria Barbosa Filho ◽  
...  
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Antifungal Agent ◽  
Antifungal Agents ◽  
Inhibitory Concentration ◽  
Inhibitory Effect ◽  
Antifungal Drugs ◽  
Additive Effects ◽  
Candida Spp ◽  
Minimum Fungicidal Concentration ◽  
Fungicide Activity

The aim of this study was to examine the effects of (-)-myrtenol alone and combined with antifungal agents against Candida spp. The Minimum Inhibitory Concentration (MIC) and Minimum Fungicidal Concentration of (-)-myrtenol and fluconazole against C. albicans and C. parapsilosis strains was obtained using CLSI guidelines. Combination of (-)-myrtenol with antifungal drugs was determined by checkboard test. The (-) myrtenol showed MIC ranging from 256 to 512 µg/mL against both species assay. And the MFC was 512 µg/mL, demonstrated nature fungicidal (MFC/MIC < 4). In addition, combination of antifungal agents (amphotericin B and fluconazole) and (-) myrtenol showed synergistic and additive effects on strains assays. Based on these results, the present study demonstrates that (-) myrtenol showed strong fungicide activity against Candida spp. In addition, Combination of antifungal agents and (-) myrtenol reduces the effective concentrations of both the agents with synergistic to additive effects. Therefore, (-) myrtenol has potential to be developed into an antifungal agent.

Antifungal prophylaxis with micafungin in neutropenic patients with hematological malignancies

2010 ◽  
Vol 51 (5) ◽  
pp. 853-859 ◽  
Author(s):  
Yuji Hirata ◽  
Taiji Yokote ◽  
Kichinosuke Kobayashi ◽  
Shoko Nakayama ◽  
Satoko Oka ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Antifungal Prophylaxis ◽  
Neutropenic Patients

Clinical Use of Caspofungin in Immunocompromised Children: A Multicenter Survey.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5066-5066
Author(s):  
Thomas Lehrnbecher ◽  
Andishe Attarbaschi ◽  
Friedhelm Schuster ◽  
Nadine Herzog ◽  
Lorenz Grigull ◽  
...  
Keyword(s):  
Adverse Events ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Antifungal Agents ◽  
Pediatric Patients ◽  
Bone Marrow Failure ◽  
Single Agent ◽  
Clinical Use ◽  
Retrospective Survey ◽  
Multicenter Survey

Abstract Background : Caspofungin (CAS) is a novel echinocandin, which is approved for several antifungal indications in adults. Although the compound is not licensed in pediatric patients (pts), it is being used in children with refractory infections or intolerance to standard antifungal agents. Methods: We conducted a multicenter retrospective survey to obtain data on clinical use, safety, and outcome in immunocompromised pediatric pts who received therapy with CAS. Results : The survey identified 71 immunocompromised children and adolescents [mean age (range) 11.4 years (5 months –26 years)]. Out of the 29 females and 42 males, 53 suffered from hematological malignancies, 10 from bone marrow failure syndromes, 3 from solid tumors, 2 from congenital immunodeficiency, and 3 from non-malignant hematological disorders. Forty-two pts (59%) had undergone allogeneic blood stem cell transplantation, and 36 pts (51%) had an ANC of less than 500/μL at baseline. CAS was administered for proven (n=18), probable (15), and possible (20) invasive fungal infection, or as empirical antifungal treatment (18). All but one pt had received prior systemic antifungal therapy with amphotericin B (52) and/or triazoles (41). The 71 pts received CAS for a mean duration of 43.5 days (range, 2–218) as single agent (22) or in combination with other antifungal agents (49). The mean maintenance dosage of CAS was 1.2 mg/kg (range, 0.4–2.9) or 34.8 mg/msqu (range, 16.3–57.5). In none of the pts, CAS was discontinued prematurely due to clinical or laboratory adverse events. Clinical adverse events were described in 35 children (49%), mostly fever (28), nausea and vomiting (18), diarrhea (8), and headache (5). Increases in hepatic or renal function parameters were frequent in these pts that received multiple other therapeutic compounds. Whereas at the end of treatment (EOT), mean GPT and GOT were slightly elevated (from 41 at baseline to 61 U/L at EOT; p=0.002 and from 29 to 80 U/L, p=0.001, respectively), mean serum creatinine, bilirubin, and alkaline phosphatase values were not different from baseline. Complete responses, partial responses, or stabilization were observed in 4/8/3 of 18 evaluable pts with proven, in 4/2/3 of 13 pts with probable, and in 3/8/2 of 15 pts with possible invasive fungal infection. Of 16 evaluable pts who received CAS empirically therapy, 10 successfully completed therapy. Overall survival was 74% at EOT and 67% at three months post EOT (65 and 60 evaluable pts, respectively). Conclusions: The data of this retrospective survey show that CAS displays acceptable safety and tolerance and may have useful antifungal efficacy for second line treatment of severely immunocompromised pediatric patients.

Cost-Effectiveness of Antifungal Strategies in High-Risk Neutropenic Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1314-1314 ◽  
Author(s):  
Michael Schwarzinger ◽  
Sylvain Baillot ◽  
Celine Beauchamp ◽  
Sebastien Maury ◽  
C. écile Pautas ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Incremental Cost ◽  
Amphotericin B ◽  
Antifungal Agent ◽  
Hematological Malignancies ◽  
Cost Effective ◽  
Antifungal Drugs ◽  
Hospitalization Costs ◽  
Neutropenic Patients

Abstract Background: Invasive fungal infections (IFIs) incur significant morbidity and mortality among neutropenic patients with hematological malignancies. Prevention and early antifungal treatment include prophylaxis where antifungal agent is started along with neutropenia; empirical therapy where antifungal agent is initiated in persistently febrile patients at least four days after neutropenia onset; preemptive therapy where antifungal agent is initiated later for a suspected IFI based on clinical symptoms, lung imaging, or biological markers. Without data from clinical trials comparing antifungal strategies, determining an optimal antifungal strategy for these patients is challenging. Objective: To determine the cost-effectiveness of all possible antifungal strategies. Target Population: Adult patients with hematological malignancies in induction chemotherapy at high risk for IFIs. Interventions: Prophylaxis with either fluconazole or posaconazole, empirical strategy, and preemptive strategy with fist-line antifungal therapy being amphotericin B, liposomal amphotericin B or caspofungin (Table). Design: Cost-effectiveness decision model. The study cohort encountered seven successive chance nodes during hospital stay: having fever; in those having fever, IFI incidence; Aspergillus or Candida species among IFI; admission in intensive care unit; dying from IFI or underlying hematological malignancy; in patients alive, having severe nephrotoxicity as defined by a twofold increase in baseline serum creatinin; dying from severe nephrotoxicity. Antifungal strategies modified the probabilities of IFI and severe nephrotoxicity that depended on both the duration and the type of antifungal drugs administered. Data Sources: PREVERT trial1, effectiveness data published to December 2007, probabilities of ICU admission and in-hospital mortality according to the occurrence of IFI in the French DRG database, life expectancy of French patients with acute myeloid leukemia, and actual French hospitalization costs (2007 euros). Time Horizon: Lifetime. Perspective: Societal. Outcome Measures: Incremental cost (euros) per discounted life-year saved averaged from 100 samples of 1000 patients (second-order probabilistic Monte Carlo simulations). Results (Table): Fluconazole prophylaxis followed by ampho-B treatment was the cheapest antifungal strategy. Posaconazole prophylaxis followed by ampho-B was nearly cost-effective (59,610 € per discounted year of life gained). Other strategies were either dominated or beyond usual societal thresholds of what may be worth it. Similar results were found in sensitivity analyses among plausible ranges. Conclusions: As compared to previous studies showing that new antifungal drugs were cost-effective within a single strategy, empirical and preemptive antifungal strategies were dominated by prophylaxis strategies. Table: Incremental cost-effectiveness ratio of antifungal strategies in high-risk neutropenic patients Total cost (2007 euros) Years of life gained ICER IFI (%) Aspergillus (%) Nephro-toxicity (%) Antifungals’ cost (2007 euros) Fluconazole then amphoB 35606 2.3448 -- 3.81% 2.61% 4.22% 909 Fluconazole then L-amphoB 36025 2.3457 (extended dominance) 3.81% 2.61% 3.67% 1430 Empirical amphoB 36033 2.3433 (dominated) 3.38% 2.3% 5.98% 1914 Posaconazole then amphoB 36065 2.3525 59,610 € 1.2% 0.81% 3.67% 2646 Preemptif amphoB 36160 2.3449 (dominated) 3.89% 2.67% 4.42% 1247 Posaconazole then L-amphoB 36389 2.3532 462,857 € 1.2% 0.81% 3.21% 3055 Fluconazole then Caspo 36557 2.3459 (dominated) 3.81% 2.61% 3.53% 1985 Preemptif L-amphoB 36616 2.3455 (dominated) 3.89% 2.67% 3.84% 1809 Posaconazole then Caspo 36828 2.3533 4,390,000 € 1.2% 0.81% 3.13% 3509 Empirical L-amphoB 37308 2.3462 (dominated) 3.38% 2.3% 4.39% 3239 Preemptif Caspo 37346 2.3458 (dominated) 3.89% 2.67% 3.55% 2597 Empirical Caspo 39123 2.3473 (dominated) 3.38% 2.3% 3.47% 5080

scholarly journals Two Case Presentations Infected byTrichosporon asahiiand Treated with Voriconazole Successfully

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Hikmet Gulsah Tanyildiz ◽  
Sule Yesil ◽  
Sule Toprak ◽  
Mehmet Onur Candir ◽  
Gurses Sahin
Keyword(s):  
Risk Factor ◽  
Fungal Infection ◽  
Liposomal Amphotericin ◽  
Antifungal Agents ◽  
Conclusive Evidence ◽  
Trichosporon Asahii ◽  
Immunosuppressed Patients ◽  
Neutropenic Patients ◽  
Case Presentations ◽  
Fatal Sepsis

Background.Trichosporon asahiiis an opportunistic fungus that causes infections in immunosuppressed patients. Neutropenia developing due to malignancies is an important risk factor for fungal infection.Case Report.We present two pediatric oncology cases successfully treated with voriconazole afterT. asahiiinfection that is known to cause fatal sepsis and invasive fungal infection.Conclusion.There is no conclusive evidence that the antifungal agent voriconazole is effective in the neutropenic patients infected withTrichosporon asahii. Liposomal amphotericin B has also been reported to be inadequate for treatment.We believe that our patients were successfully treated and survived because the antifungal agents were started early and properly, although the infection can be fatal in up to 80% of cases despite treatment.

scholarly journals Micafungin Compared with Caspofungin for the Treatment of Febrile Episodes in Neutropenic Patients with Hematological Malignancies: A Retrospective Study

2014 ◽  
Vol 25 (6) ◽  
pp. 299-304 ◽  
Author(s):  
Sarah Shalhoub ◽  
Luchen Wang ◽  
Arthur Ching ◽  
Shahid Husain ◽  
Coleman Rotstein
Keyword(s):  
Fungal Infection ◽  
Hematological Malignancies ◽  
Fungal Infections ◽  
Prospective Trial ◽  
Invasive Fungal Disease ◽  
Invasive Fungal Infections ◽  
Successful Outcome ◽  
European Organization ◽  
Neutropenic Patients ◽  
Revised Definitions

BACKGROUND: Invasive fungal infections are associated with morbidity and mortality in neutropenia secondary to hematological malignancies. Empirical antifungal agents are used to reduce their consequences. Caspofungin is the only echinocandin approved for this indication. Micafungin was compared with caspofungin for the treatment of patients with hematological malignancies and prolonged neutropenia.METHODS: A retrospective cohort study was conducted involving patients who had hematological malignancies with profound neutropenia for a minimum of 10 days, and received empirical micafungin or caspofungin for a minimum of five days, between April 2005 and November 2009. Successful outcome was based on a composite end point: survival for a minimum of seven days following antifungal cessation, successful treatment of baseline fungal infection, absence of adverse events and absence of breakthrough fungal infection. Fungal infections were defined according to revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC-MSG) criteria, with modification of the diagnostic imaging criteria.RESULTS: Micafungin had similar overall success to caspofungin (60.4% [29 of 48] versus 57.3% [47 of 82], respectively; P=0.729). Survival was higher in the micafungin group compared with the caspofungin group (100% [48 of 48] versus 89% [73 of 82]; P=0.02). No baseline invasive fungal infections were identified in the micafungin group, compared with three proven infections treated successfully with caspofungin (3.7%; P=0.18). Three proven breakthrough infections were observed in the micafungin group (three of 48 [27.3%]) compared with none in the caspofungin group (zero of 82; P=0.02).CONCLUSION: Micafungin has similar efficacy to caspofungin as empirical antifungal therapy in febrile neutropenic patients with hematological malignancies. Verification of these results in a prospective trial is warranted.

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