Use of micafungin versus fluconazole for antifungal prophylaxis in neutropenic patients receiving hematopoietic stem cell transplantation.
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.
Hiramatsu
Yasushi
Y
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
Maeda
Yoshinobu
Y
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
Fujii
Nobuharu
N
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
Saito
Takashi
T
Department of Infection Control and Prevention, Kyoto University Hospital, Kyoto, Japan.
Nawa
Yuichiro
Y
Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Hara
Masamichi
M
Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Yano
Tomofumi
T
Department of Hematology, Okayama Rousai Hospital, Okayama, Japan.
Asakura
Shoji
S
Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
Sunami
Kazutaka
K
Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
Tabayashi
Takayuki
T
Department of Internal Medicine, Chugoku Central Hospital, Hiroshima, Japan.
Miyata
Akira
A
Department of Internal Medicine, Chugoku Central Hospital, Hiroshima, Japan.
Matsuoka
Ken-Ichi
KI
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
Shinagawa
Katsuji
K
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
Ikeda
Kazuma
K
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
Matsuo
Keitaro
K
Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Aichi, Nagoya, Japan.
Tanimoto
Mitsune
M
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.
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
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D000077551:Micafungin