Efficacy and safety of micafungin for invasive candida infections: a
meta-analysis of randomized controlled trials.
Author(s): Chen Q, Lin MH, Chen ML, Liu ZY, Chai D, Wang R.
Affiliation(s): Department of Clinical Pharmacology, Chinese People's Liberation Army General
Hospital, Beijing 100853, China.
Publication date & source: 2012, Chin Med J (Engl). , 125(2):345-51
BACKGROUND: Invasive fungal infections such as candidiasis and mold infections
cause significant morbidity and mortality in seriously ill patients. Micafungin
is an echinocandin antifungal agent with potent activity against most species of
Candida and Aspergillus. We did this meta-analysis to clarify whether micafungin
offers superior efficacy and safety compared with other antifungal agent for
treating infections associated with invasive candidiasis.
METHODS: We did a meta-analysis of randomized controlled trials to examine
whether micafungin has superior efficacy and safety compared with other
antifungal agents recommended by the treatment guidelines for fungal infection.
Seven trials involving 2913 patients were included in this analysis. Odds ratios
(OR) and 95% confidence intervals (CI) were calculated.
RESULTS: Micafungin was associated with significantly better treatment success
compared with the comparator antifungal agents (modified intention to treat, 2851
patients; random-effects model, OR 1.20, 95%CI 1.00 - 1.45, P = 0.0487). In
addition, micafungin was more effective than the comparators for antifungal
prophylaxis of neutropenic patients undergoing hematopoietic stem cell
transplantation (OR 1.47, 95%CI 1.08 - 2.00, P = 0.01). Although there was no
significant difference between the compared regimens in terms of the incidence of
adverse drug effects (OR 0.94, 95%CI 0.77 - 1.11), fewer patients treated with
micafungin withdrew from the studies because of adverse events (OR 0.64, 95%CI
0.44 - 0.94).
CONCLUSIONS: Micafungin has a good safety and tolerability profile, with an
efficacy at least comparable to the other antifungal agents. Micafungin offers
advantages over other agents for antifungal prophylaxis. Micafungin offers an
appropriate alternative for antifungal prophylaxis rather than the treatment of
invasive candida infections.
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