title: 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.
authors.affiliation: Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hiramatsu
authors.affiliation: Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Fujii
authors.affiliation: Department of Infection Control and Prevention, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Saito
authors.affiliation: Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Nawa
authors.affiliation: Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Hara
authors.affiliation: Department of Hematology, Okayama Rousai Hospital, Okayama, Japan.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Yano
authors.affiliation: Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Asakura
authors.affiliation: Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Sunami
authors.affiliation: Department of Internal Medicine, Chugoku Central Hospital, Hiroshima, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tabayashi
authors.affiliation: Department of Internal Medicine, Chugoku Central Hospital, Hiroshima, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Miyata
authors.affiliation: Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Matsuoka
authors.affiliation: Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shinagawa
authors.affiliation: Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Aichi, Nagoya, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan. tanimoto@md.okayama-u.ac.jp.|Department of Internal Medicine, Okayama University, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan. tanimoto@md.okayama-u.ac.jp.
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D054714:Echinocandins / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage* / Q000009:adverse effects; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D055666:Lipopeptides / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D009503:Neutropenia; D011446:Prospective Studies; D014184:Transplantation, Homologous
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D000077551:Micafungin