Comparison of micafungin and voriconazole in the treatment of invasive fungal infections in kidney transplant recipients

Shang, Wu; Gao, Feng; Sun, Rongqing; Wang, X.; Liu, W.; Zhang, S.; Li, J.; Pang, Xiaoli; Wang, Y.; Zhang, W.

doi:10.1111/j.1365-2710.2012.01362.x

Cited by 11 publications

(13 citation statements)

References 18 publications

(22 reference statements)

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“…However, there were significantly positive outcomes for the prevention model [35]. Our pooled analysis of 9 RCTs with a total of 2,008 patients confirmed that MCFG had a higher treatment success rate for the prevention model, but not for the empiric treatment model.…”

Section: Discussionmentioning

confidence: 62%

Efficacy and safety of micafungin versus extensive azoles in the prevention and treatment of invasive fungal infections for neutropenia patients with hematological malignancies: A meta-analysis of randomized controlled trials

Lee

Lin

et al. 2017

PLoS ONE

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BackgroundCurrent studies that compare the efficacy and safety of micafungin (MCFG) with that of triazoles for the prophylaxis and treatment of invasive fungal infections (IFIs) demonstrate a lack of sufficient evidence and yield conflicting results. To compare the efficacy and safety of MCFG and triazoles in the prevention and treatment of IFIs, we conducted a meta-analysis and trial sequential analysis (TSA).MethodsFor the meta-analysis, we systematically searched the databases of PubMed, Embase and Cochrane Central Register of Controlled Trials and relevant database articles for randomized controlled studies published through November 2016. Comparative studies of the efficacy and safety of MCFG versus triazoles in the prevention and treatment of IFIs were selected. Meta-analysis was performed by R software with the “metafor” package. Pooled results were expressed as risk ratios (RRs) with corresponding 95% confidence intervals (CI). TSA was adopted to assess the studies’ power with TSA version 0.9 beta.ResultsNine current studies were included in the meta-analysis (1049 cases and 959 controls). Pooled trial comparisons indicated that MCFG does have significantly higher treatment success rates (RR = 1.13; 95% CI, 1.02–1.25; p = 0.0205) and reduces the number of overall IFIs (RR = 0.75; 95% CI, 0.61–0.92; p = 0.0056). However, MCFG demonstrates no difference in all-cause mortality (RR = 0.76; 95% CI, 0.52–1.12, p = 0.1624). For the safety evaluation, MCFG had a significantly lower incidence of severe adverse events (AEs) (RR = 0.45; 95% CI, 0.25–0.83; p = 0.0105), hepatic impairment (RR = 0.70; 95% CI, 0.50–0.97; p = 0.0363) and premature discontinuation (RR = 0.51; 95% CI, 0.34–0.76, p = 0.0010). Meta-regression analysis disclosed the correction of mean age and treatment success rates (P < 0.0001). Meanwhile, TSA demonstrated sufficient power to show efficacy.ConclusionsThe treatment success rate of MCFG is superior to that of triazoles for the prophylaxis and treatment of IFIs, and correction of the mean patient age demonstrates that efficacy increases as patient age decreases. MCFG appears to be well-tolerated with manageable side effects and lower withdrawal rates. However, additional clinical trials should be conducted on specific drug-related mortality and AEs to gather sufficient evidence on these matters.

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Section: Discussionmentioning

confidence: 62%

Efficacy and safety of micafungin versus extensive azoles in the prevention and treatment of invasive fungal infections for neutropenia patients with hematological malignancies: A meta-analysis of randomized controlled trials

Lee

Lin

et al. 2017

PLoS ONE

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“…Among all of the included trials, six studies [ 20 , 22 – 26 ] were related to the treatment of proven/probable fungal infections, while four studies [ 21 , 27 – 29 ] were involved in the prophylaxis for high risk of fungal infections. One trial compared caspofungin with fluconazole [ 20 ], one trial compared caspofungin with itraconazole [ 21 ], one trial compared anidulafungin with fluconazole [ 22 ], four trials compared micafungin with fluconazole [ 23 , 24 , 27 , 29 ], two trials compared micafungin with voriconazole [ 25 , 26 ], and one trial compared micafungin with itraconazole [ 28 ]. In terms of methodology, all of the included trials were deemed to be of good quality according to the Jadad score (≥2), with nine trials being multicenter randomized and double-blinded, and the last being randomized and open-labeled.…”

Section: Resultsmentioning

confidence: 99%

“…50 mg q.d. Itraconazole: oral 5 mg/kg/day (in two administrations) 287 136/137 3 Shang et al, 2012 [ 25 ] Multicenter, open-label RCT Kidney transplant recipients with IFI Micafungin: i.v. 100 mg/day (<60 kg) or 150 mg/day (>60 kg) Voriconazole: i.v.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of echinocandins versus triazoles for the prophylaxis and treatment of fungal infections: a meta-analysis of RCTs

Wang

Xue

Zhu

2014

Eur J Clin Microbiol Infect Dis

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Echinocandins and triazoles were proven to be effective antifungal drugs against invasive fungal infections (IFI), which may cause significant morbidity and mortality in immunocompromised patients. The aim of this study was to compare the efficacy and safety between echinocandins and triazoles for the prophylaxis and treatment of fungal infections. PubMed, Embase, and the Cochrane Library were searched to identify relevant randomized controlled trials (RCTs) up to July 2014. The quality of trials was assessed with the Jadad scoring system. The primary outcomes of interest were treatment success, microbiological success, breakthrough infection, drug-related adverse events (AEs), withdrawals due to AEs, and all-cause mortality. Ten RCTs, involving 2,837 patients, were included, as follows: caspofungin versus fluconazole (n = 1), caspofungin versus itraconazole (n = 1), anidulafungin versus fluconazole (n = 1), micafungin versus fluconazole (n = 4), micafungin versus voriconazole (n = 2), and micafungin versus itraconazole (n = 1). Echinocandins and triazoles showed similar effects in terms of favorable treatment success rate [relative risk (RR) = 1.02, 95 % confidence interval (CI), 0.97–1.08], microbiological success rate (RR = 0.98, 95 % CI, 0.90–1.15), breakthrough infection (RR = 1.09; 95 % CI, 0.59–2.01), drug-related AEs (RR = 0.94; 95 % CI, 0.71–1.15), and all-cause mortality (RR = 0.85; 95 % CI, 0.66–1.10) in the prophylaxis and treatment of fungal infections. Additionally, echinocandins were more effective than triazoles for prophylaxis in patients undergoing hematologic malignancies or those who received hematopoietic stem cell transplantation (HSCT; RR = 1.08; 95 % CI, 1.02–1.15). Echinocandins significantly decreased the AE-related withdrawals rate compared with triazoles (RR = 0.47; 95 % CI, 0.33–0.67). This meta-analysis revealed that echinocandins are as effective and safe as triazoles for the prophylaxis and treatment of patients with fungal infections.

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“…But its use is very limited now-a-days due to its severe side effects such as electrolyte disturbances and nephrotoxicity. 4,5 Many antifungal agents are available during the past 25 years with broad spectrum antifungal activity. Voriconazole is one of the second generation synthetic triazole with broad spectrum antifungal activity and is available in oral and intravenous formulations.…”

Section: Introductionmentioning

confidence: 99%

Safety of voriconazole in treatment of fungal infections

Mohan¹,

Mohan

Sangal³

et al. 2020

Int J Res Dermatol

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Immunocompromised patients are at more risk in developing fungal infections particularly with Candida and Aspergillus species being the mycoses most commonly identified. Previously, amphotericin-B is the drug of choice for the treatment of systemic infections caused by Candida and Aspergillus species. Due to its high incidence of toxicity, its use has been limited in many cases. Voriconazole is the newest triazole synthesized against fungal infections and was approved by FDA in 2002 for the treatment of invasive aspergillosis and refractory infections of Scedosporium apiospermum and Fusarium spp.

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Comparison of micafungin and voriconazole in the treatment of invasive fungal infections in kidney transplant recipients

Abstract: This is the first comparison of micafungin and voriconazole in renal transplant patients. Our study shows that the effectiveness of micafungin was similar to that of voriconazole in such patients.

Cited by 11 publications

References 18 publications

Efficacy and safety of micafungin versus extensive azoles in the prevention and treatment of invasive fungal infections for neutropenia patients with hematological malignancies: A meta-analysis of randomized controlled trials

Efficacy and safety of micafungin versus extensive azoles in the prevention and treatment of invasive fungal infections for neutropenia patients with hematological malignancies: A meta-analysis of randomized controlled trials

Efficacy and safety of echinocandins versus triazoles for the prophylaxis and treatment of fungal infections: a meta-analysis of RCTs

Safety of voriconazole in treatment of fungal infections

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