Screening data from the Hypertension Detection and Follow-up Program in Minneapolis, MN, 1973-1974, provided an opportunity to evaluate the accuracy of self-report of height and weight. It was found that both were reported, on the average, with small but systematic errors. Large errors were found in certain population subgroups. Also, men and women differed somewhat in their pattern of misreporting. Weight was understated by 1.6% by men and 3.1% by women, whereas height was overstated by 1.3% by men and 0.6% by women. As in previous studies, it was found that the most important correlates of the amount of error were the actual measurements of height and weight. An interesting finding was that misreporting of both height and weight in men was correlated with both aspects of body size, whereas for women, it was related mainly to the characteristic in question. Certain other demographic variables, such as age and educational level, were also found to have some importance as factors influencing misreporting.

Caspofungin is a new broad-spectrum antifungal drug. A multicenter, double-blind, randomized trial was conducted to assess the efficacy, safety, and tolerability of caspofungin relative to amphotericin B in adults with endoscopically documented symptomatic Candida esophagitis. By use of a modified intent-to-treat analysis, endoscopically verified clinical success was achieved in 74% (95% confidence interval [CI], 59%-86%) and 89% (95% CI, 72%-98%) of patients receiving caspofungin at 50 and 70 mg/day, respectively, and in 63% (95% CI, 49%-76%) of patients given amphotericin B at 0.5 mg/kg/day. Therapy was stopped because of drug-related adverse events in 24% of patients in the amphotericin B group and 4% and 7%, respectively, for the caspofungin groups. This report provides the first demonstration of clinical utility for an echinocandin compound. Caspofungin appeared in this study to be as effective as and better tolerated than amphotericin B for the treatment of esophageal candidiasis.

Caspofungin is an antifungal agent of the novel echinocandin class. We investigated its efficacy, safety, and tolerability as therapy for oropharyngeal and/or esophageal candidiasis in a phase II dose-ranging study. Patients were randomized in a double-blind manner to receive either caspofungin acetate (35, 50, or 70 mg) or amphotericin B (0.5 mg/kg of body weight) intravenously once daily for 7 to 14 days. A favorable response required both complete resolution of symptoms and quantifiable improvement of mucosal lesions 3 to 4 days after discontinuation of study drug. Efficacy was assessed using a modified intent-to-treat analysis. No hypothesis testing of efficacy was planned or performed. Of 140 enrolled patients, 63% had esophageal involvement and 98% were infected with the human immunodeficiency virus (HIV) (median CD4 count, 30/mm 3 ). A modestly higher proportion of patients in each of the caspofungin groups (74 to 91%) achieved favorable responses compared to amphotericin B recipients (63%), but there was considerable overlap in the 95% confidence intervals surrounding these point estimates. Similar trends were found in the subgroups with esophageal involvement, a history of fluconazole failure, and CD4 counts of <50/mm 3 . A smaller proportion of patients receiving any dose of caspofungin experienced drug-related adverse events compared to patients given standard doses of conventional amphotericin B (P < 0.01). Caspofungin provided a generally well-tolerated parenteral therapeutic option for HIV-infected patients with oropharyngeal and/or esophageal candidiasis in this study.Mucosal candidiasis, although not life-threatening, causes significant morbidity in patients infected with the human immunodeficiency virus (HIV) (16). The development of drug resistance in the causative strain or the selection of intrinsically more resistant species may complicate therapy of recurrent candidal infections (19,20,28,34,36,40,43). This study describes the use of a new echinocandin, caspofungin (Cancidas; formerly MK-0991), as treatment for oropharyngeal and esophageal candidiasis in an immunocompromised patient population.Oral fluconazole is widely regarded as the treatment of choice for mucosal candidiasis under most circumstances (36). Amphotericin B deoxycholate has been the standard recourse for patients infected with Candida sp. unresponsive to azole therapy (5,10,24,36). The use of conventional amphotericin B preparations is complicated by its significant toxicity. Newer lipid formulations of amphotericin have reduced, but not eliminated, some of these adverse effects (15).Caspofungin possesses activity in vitro (6,17,23,30,31,42) and in vivo (1, 2, 11, 13) against a variety of fungal pathogens, including Candida and Aspergillus species. Echinocandins noncompetitively inhibit 1,3-␤-D-glucan synthesis, interfering with the normal formation of the fungal cell wall (3). Since glucans are not present in mammalian cells, it is hoped that echinocandins will have a relatively high therapeutic index. Crossresistance with...

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