Efficacy and safety of micafungin for treating febrile neutropenia in hematological malignancies.
Less toxic antifungal drugs are required for empirical antifungal therapy. Micafungin is an echinocandin drug that is effective against both Candida and Aspergillus, and preliminary clinical studies have shown good antifungal activity. We prospectively examined the effect and safety of micafungin against febrile neutropenia with suspected fungal infection in 53 patients (median age, 56 years) who had undergone chemotherapy. The administered dose of micafungin was 150 mg/day, and its effect was evaluated as fever resolution as well as the results of chest imaging and serum fungal tests. Micafungin levels were measured on day 4 after the first administration using high-performance liquid chromatography. We also measured trough levels of micafungin. Underlying diseases comprised acute lymphoblastic leukemia (n = 4), acute myeloid leukemia (n = 20), multiple myeloma (n = 3), and non-Hodgkin's lymphoma (n = 26). The overall efficacy of micafungin was 70%. Breakthrough fungal infections were documented in two (3.8%) patients, both of whom died of invasive mycosis. None of the patients were switched to other antifungal drugs due to events unrelated to adverse effects. Plasma levels of micafungin and the degree of hepatic or renal dysfunction did not correlate. Micafungin is safe and effective for the empirical antifungal therapy of febrile neutropenia in patients with hematological malignancies.
Goto
Naoe
N
First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Japan.
Hara
Takeshi
T
Tsurumi
Hisashi
H
Ogawa
Kengo
K
Kitagawa
Junichi
J
Kanemura
Nobuhiro
N
Kasahara
Senji
S
Yamada
Toshiki
T
Shimizu
Masahito
M
Nakamura
Mitsuhiro
M
Matsuura
Katsuhiko
K
Moriwaki
Hisataka
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents; D000970:Antineoplastic Agents / Q000009:adverse effects; D016903:Drug Monitoring; D064420:Drug-Related Side Effects and Adverse Reactions; D054714:Echinocandins / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use / Q000633:toxicity; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000382:microbiology; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases; D055666:Lipopeptides / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use / Q000633:toxicity; D008107:Liver Diseases; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009181:Mycoses / Q000139:chemically induced / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016896:Treatment Outcome
D000935:Antifungal Agents; D000970:Antineoplastic Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin