Caspofungin for the treatment of fungal infections: a systematic review of randomized controlled trials

Falagas, Matthew E.; Ntziora, Fotinie; Betsi, Gregoria I.; Samonis, George

doi:10.1016/j.ijantimicag.2006.09.018

Cited by 27 publications

(20 citation statements)

References 69 publications

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“…7 In this study, caspofungin was more effective and the incidence of adverse events was lower, results similar to the findings of other pediatric studies [12][13][14] and those of Mora et al, who studied the use of this drug in adult patients with invasive candidiasis. 15 At a higher level of evidence, the systematic review by Falagas et al, 16 about adolescent and adult patients, in which, in agreement with our observations in the pediatric stage, they conclude that caspofungin could be an alternative agent in the treatment of invasive candidiasis y candidiasis esophagitis, since it has the same efficacy and less toxicity, without any changes in the mortality rate, as stated in other reports. 17 The greatest contribution of this study is to be the first systematic review and meta-analysis on the efficacy of caspofungin in children and evidences the urgent need of conducting adequate studies with the necessary power to clearly respond to the question about the best antifungal agent to treat IFI in this population since the current evidence is modest and insufficient to ascertain the opinion.…”

supporting

confidence: 90%

Efficacy and safety of caspofungin in children: systematic review and meta-analysis

et al. 2016

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Invasive fungal infections are a significant cause of morbidity and mortality in children. Caspofungin is an echinocandin used as an alternative treatment in the prevention and/or treatment of certain invasive fungal infections in children, although compared to the standard treatment there is little evidence on its efficacy and safety. Objectives. To evaluate the efficacy and safety of caspofungin compared with other antifungal drugs for the prevention and/or treatment of invasive fungal infections in children. Material and methods. The objective of the initial search strategy was to identify randomized controlled studies of acceptable methodological quality (Jadad scale >3), through the key word "caspofungin", conducted in patients with an age range from 0 to 18 years old. Results. Only 3 publications met the inclusion criteria. Two of them were studies conducted in children and one in newborn infants. A higher incidence of adverse events was not documented for caspofungin and its efficacy was not different from that of other antifungal drugs (typical RR 1.47; CI 95%: 0.78-2.79). Conclusions. This systematic review suggests that caspofungin could be considered as an alternative drug in children for the prevention and treatment of invasive fungal infections. However, given the small number of existing publications, more studies are required to reach definite conclusions.

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supporting

confidence: 90%

Efficacy and safety of caspofungin in children: systematic review and meta-analysis

et al. 2016

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“…The Medical Subjects Heading (MeSH) terms used for keyword and text word searches included antifungals, amphotericin, Ambisome, itraconazole, fluconazole, voriconazole, posaconazole, caspofungin, micafungin, anidulafungin, fungemia, aspergillosis, and candidiasis. The references of 13 review articles on treatments for invasive fungal infection and empirical antifungal treatments for febrile neutropenia were examined to identify additional studies that were not found in the computerized databases (7,16,24,27,28,29,47,34,41,50,67,68,71). Additional reports were identified from the reference lists of those articles.…”

Section: Methodsmentioning

confidence: 99%

“…However, hepatotoxic reactions to antifungal agents were increasingly reported and ranged from mild and asymptomatic abnormalities in liver function test results to potentially fatal fulminant hepatic failure (17,20,25,35,74,88). While individual reviews of new antifungal agents have been published (7,16,24,27,28,29,34,41,47,50,67,68,71), there has been no systematic evaluation of the liver toxicity associated with these treatments. We conducted a systematic review and meta-analysis to evaluate the safety information from published studies of definitive therapy for invasive fungal infection and empirical antifungal use for prolonged febrile neutropenia and calculated the absolute risk estimates associated with these treatment regimens.…”

mentioning

confidence: 99%

Systematic Review and Meta-Analysis of the Tolerability and Hepatotoxicity of Antifungals in Empirical and Definitive Therapy for Invasive Fungal Infection

Wang

Chang

Young‐Xu³

et al. 2010

Antimicrob Agents Chemother

145

137

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To evaluate the tolerability and liver safety profiles of the systemic antifungal agents commonly used for the treatment of invasive fungal infection, we conducted a systematic review and meta-analysis of randomized controlled trials published before 31 August 2009. Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. We used the beta-binomial model to account for variation across studies and the maximum likelihood method to estimate the pooled risks. We identified 39 studies with more than 8,000 enrolled patients for planned comparisons. The incidence rates of treatment discontinuation due to adverse reactions and liver injury associated with antifungal therapy ranged widely. The pooled risks of treatment discontinuation due to adverse reactions were above 10% for amphotericin B formulations and itraconazole, whereas they were 2.5% to 3.8% for fluconazole, caspofungin, and micafungin. We found that 1.5% of the patients stopped itraconazole treatment due to hepatotoxicity. Furthermore, 19.7% of voriconazole users and 17.4% of itraconazole users had elevated serum liver enzyme levels, although they did not require treatment discontinuation, whereas 2.0% or 9.3% of fluconazole and echinocandin users had elevated serum liver enzyme levels but did not require treatment discontinuation. The results were similar when we stratified the data by empirical or definitive antifungal therapy. Possible explanations for antifungal agent-related hepatotoxicity were confounded by antifungal prescription to patients with a high risk of liver injury, the increased chance of detection of hepatotoxicity due to prolonged treatment, or the pharmacological entity.Invasive fungal infection is a leading cause of morbidity and mortality among immunocompromised and debilitated patients, including those with hematological malignancy, solid organ or bone marrow transplantation, and neutropenia and those receiving systemic corticosteroid therapy. Candida species and Aspergillus species are the two predominant causative fungi, with the case fatality rates being 30% and 50% among those infected with members of these two fungal genera, respectively (19,53). Over the past few decades, amphotericin B has been the mainstay treatment of candidiasis and aspergillosis, whereas fluconazole has been extensively used among patients with Candida albicans infection. After randomized controlled trials showed that extended-spectrum azoles (itraconazole, voriconazole, posaconazole) and echinocandins (anidulafungin, caspofungin, micafungin) had efficacies similar to those of amphotericin B and fluconazole, these newer antifungal agents have been used more frequently for the treatment of patients with probable or proven invasive fungal infection (18,32,56,59,81). Current practice guidelines recommend amphotericin B formulations, fluconazole, and echinocandins as first-line therapy for patients with candidemia; and amphotericin B formulations or voriconazole are the drugs of choice for the primary therapy of i...

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“…to this chemotherapeutic reported elsewhere [5,6,10,11]. Falagas et al [13] observed high effectiveness of caspofungin -a new echinocandin exhibiting lower toxicity in comparison to amphotericin B, in the treatment of patients with fungal infections caused mainly by Candida spp. In our study, caspofungin was also found to be very effective as indicated by the complete absence of resistance observed in the tested strains.…”

Section: Discussionmentioning

confidence: 92%

“…strains isolated from different clinical materials to antifungal agents have been published widely [5][6][7][8][9][10][11][12][13]. However, data concerning the susceptibility of clinical yeast isolates both to antifungal drugs and fungicidal agents used for disinfection and antisepsis procedures are limited.…”

Section: Introductionmentioning

confidence: 99%

Susceptibility of Candida spp. clinical isolates to antimycotics and disinfectants

et al. 2010

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Abstract:The incidence of candidiasis among immunocompromised patients and emergence of antimycotics resistant strains has increased significantly. The aims of this study were: to examine the in vitro activity of antimycotics and biocides against Candida clinical isolates; to detect cross-resistance of fungi to these preparations and to estimate whether disinfectants applied in hospital areas are active against clinical Candida isolates. In vitro susceptibility of 102 Candida isolates to eight antimycotics was examined by Etest and ATB Fungus. Sensitivity of these strains to four disinfectants and an antiseptic agent was tested according to EN 1275:2005. Amphotericin B, caspofungin and 5-fluorocytosine were the most effective antimycotics against all Candida isolates. Resistance to itraconazole and fluconazole was observed among C. krusei and C. glabrata. The MICs (Minimal Inhibitory Concentrations) for ketoconazole, voriconazole and posaconazole against Candida albicans ranged: 0.003 ->32 µg/ml and one strain was resistant to three agents tested. All analysed Candida strains were sensitive to biocides containing either chlorine, aldehyde, alcohol mixtures, glucoprotamin or chlorhexidine gluconate with isopropanol. Sensitivity to these agents was observed at concentrations lower than those concentrations recommended by manufacturers to achieve proper biocidal activity to those preparations. Our data suggest that these disinfectants can be effectively applied in clinical wards to prevent nosocomial Candida infections.

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Caspofungin for the treatment of fungal infections: a systematic review of randomized controlled trials

Cited by 27 publications

References 69 publications

Efficacy and safety of caspofungin in children: systematic review and meta-analysis

Efficacy and safety of caspofungin in children: systematic review and meta-analysis

Systematic Review and Meta-Analysis of the Tolerability and Hepatotoxicity of Antifungals in Empirical and Definitive Therapy for Invasive Fungal Infection

Susceptibility of Candida spp. clinical isolates to antimycotics and disinfectants

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