title: Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis.
abstract: BACKGROUND
  Invasive candidiasis is an important cause of morbidity and mortality among patients with health care-associated infection. The echinocandins have potent fungicidal activity against most Candida species, but there are few data comparing the safety and efficacy of echinocandins in the treatment of invasive candidiasis.
  
  
  METHODS
  This was an international, randomized, double-blind trial comparing micafungin (100 mg daily) and micafungin (150 mg daily) with a standard dosage of caspofungin (70 mg followed by 50 mg daily) in adults with candidemia and other forms of invasive candidiasis. The primary end point was treatment success, defined as clinical and mycological success at the end of blinded intravenous therapy.
  
  
  RESULTS
  A total of 595 patients were randomized to one the treatment groups and received at least 1 dose of study drug. In the modified intent-to-treat population, 191 patients were assigned to the micafungin 100 mg group, 199 to the micafungin 150 mg group, and 188 to the caspofungin group. Demographic characteristics and underlying disorders were comparable across the groups. Approximately 85% of patients had candidemia; the remainder had noncandidemic invasive candidiasis. At the end of blinded intravenous therapy, treatment was considered successful for 76.4% of patients in the micafungin 100 mg group, 71.4% in the micafungin 150 mg group, and 72.3% in the caspofungin group. The median time to culture negativity was 2 days in the micafungin 100 mg group and the caspofungin group, compared with 3 days in the micafungin 150 mg groups. There were no significant differences in mortality, relapsing and emergent infections, or adverse events between the study arms.
  
  
  CONCLUSIONS
  Dosages of micafungin 100 mg daily and 150 mg daily were noninferior to a standard dosage of caspofungin for the treatment of candidemia and other forms of invasive candidiasis.
authors.affiliation: Div. of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA. pappas@uab.edu
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
authors.forename: Coleman M F
authors.initials: CM
authors.lastname: Rotstein
authors.forename: Robert F
authors.initials: RF
authors.lastname: Betts
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.forename: Deepak
authors.initials: D
authors.lastname: Talwar
authors.forename: Jan J
authors.initials: JJ
authors.lastname: De Waele
authors.forename: Jose A
authors.initials: JA
authors.lastname: Vazquez
authors.forename: Bertrand F
authors.initials: BF
authors.lastname: Dupont
authors.forename: David L
authors.initials: DL
authors.lastname: Horn
authors.forename: Luis
authors.initials: L
authors.lastname: Ostrosky-Zeichner
authors.forename: Annette C
authors.initials: AC
authors.lastname: Reboli
authors.forename: Byungse
authors.initials: B
authors.lastname: Suh
authors.forename: Raghunadharao
authors.initials: R
authors.lastname: Digumarti
authors.forename: Chunzhang
authors.initials: C
authors.lastname: Wu
authors.forename: Laura L
authors.initials: LL
authors.lastname: Kovanda
authors.forename: Leah J
authors.initials: LJ
authors.lastname: Arnold
authors.forename: Donald N
authors.initials: DN
authors.lastname: Buell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D002177:Candidiasis / Q000188:drug therapy*; D000077336:Caspofungin; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D054714:Echinocandins; D005260:Female; D016469:Fungemia / Q000188:drug therapy*; D006801:Humans; D055666:Lipopeptides; D008074:Lipoproteins / Q000008:administration & dosage*; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000008:administration & dosage*; D016896:Treatment Outcome