Use of micafungin versus fluconazole for antifungal prophylaxis in neutropenic patients receiving hematopoietic stem cell transplantation

Abstract

A prospective randomized clinical trial assessed the efficacy and tolerance of micafungin compared with that of standard fluconazole treatment in patients undergoing hematopoietic stem cell transplantation (HSCT). Adult patients (n = 106) were randomly assigned to receive prophylaxis with either micafungin 150 mg (n = 52), or fluconazole 400 mg (n = 52). Success was defined as the absence of suspected, proven, or probable invasive fungal infection (IFI) through the end of therapy and the absence of proven or probable IFI through the end of the 4-week period following treatment. The overall efficacy of micafungin was comparable to that of fluconazole (94 vs. 88%; difference 6.0%; 95% confidence interval, -5.4 to +17.4%; P = 0.295). A total of 2 (4.0%) of 50 patients in the micafungin arm and 6 (12.0%) of 50 patients in the fluconazole arm received empirical antifungal therapy (P = 0.06). Micafungin treatment did not result in increasing adverse effects and had a safe profile as fluconazole in neutropenic patients. This randomized trial indicates that the efficacy and tolerance of micafungin 150 mg was comparable to that of fluconazole 400 mg, suggesting that micafungin at 150 mg daily represents a valuable new treatment option for antifungal prophylaxis in HSCT recipients.

Safety and Efficacy of Intermittent Intravenous Administration of High-Dose Micafungin

“…This was consistent with breakthrough rates ranging between 5.3% and 7.3% reported in antifungal prophylactic clinical trials [1,2,[15][16][17]. One breakthrough bloodstream infection with Rhodotorula species was identified, which was consistent with the susceptibility profile of this organism [18].…”

Efficacy and safety of micafungin for the prophylaxis of invasive fungal infection during neutropenia in children and adolescents undergoing allogeneic hematopoietic SCT

“…7,20 The treatment efficacy of micafungin in this study was comparable to that of micafungin prophylaxis reported in adult populations. 7,17 Furthermore, micafungin showed 100% efficacy for preventing any proven fungal infection, not only during the neutropenic phase but also 4 weeks after stopping micafungin prophylaxis.…”

Characterisation of breakthrough invasive mycoses in echinocandin recipients: an evidence-based review

“…Echinocandins were used as primary prophylaxis in eight studies and as secondary prophylaxis in one study (Table 1) [25][26][27][28][29][30][31][32][33]. Underlying diseases of the study populations are presented in Table 1.…”