Comparative efficacy of echinocandins and nonechinocandins for the treatment of Candida parapsilosis Infections: a meta-analysis.
OBJECTIVE
To compare the efficacy of echinocandins and nonechinocandins in the treatment of candidemia or invasive candidiasis due to Candida parapsilosis.


METHODS
Meta-analysis of five randomized, blinded, comparative trials.


METHODS
A total of 1169 patients (mean age 55.5 yrs, 57.8% male) with invasive candidiasis or candidemia treated with an echinocandin or other antifungal agents.


RESULTS
The PubMed, MEDLINE, Toxnet, and Cochrane Central Register of Controlled Trials databases were searched for relevant English-language articles to identify appropriate randomized trials. The quality of studies was assessed with the Jadad scoring system. Data on number of patients, age, and treatment success rate were extracted by two investigators independently into a standardized data collection form. Overall C. parapsilosis treatment success rates with echinocandins were compared with nonechinocandins. Jadad scores of the five studies that met all of the selection criteria ranged from 2-5 (out of 5), with a median of 4. Among the 1169 patients with invasive candidiasis or candidemia, 202 (17.3%) had C. parapsilosis. Among these C. parapsilosis cases, 102 received an echinocandin and 100 received a comparator drug. The success rates of treating C. parapsilosis were similar for the echinocandin group versus other antifungal treatment groups (76.5% [78/102] vs 73% [73/100]). A fixed-effects model was applied secondary to a low level of heterogeneity among the studies (I²=0%). The combined risk ratio demonstrated that echinocandins are not significantly different from other antifungal agents for the treatment of candidemia or invasive candidiasis due to C. parapsilosis (risk ratio 1.03, 95% confidence interval 0.88-1.21).


CONCLUSIONS
Echinocandins are as effective as comparator drugs for the treatment of candidemia or invasive candidiasis due to C. parapsilosis.
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Science, Wayne State University, Detroit, Michigan, USA. pkale@wayne.edu
Pramodini B
PB
Kale-Pradhan
Geoffrey
G
Morgan
Sheila M
SM
Wilhelm
Leonard B
LB
Johnson
D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects*; D058387:Candidemia / Q000188:drug therapy*; D058365:Candidiasis, Invasive / Q000188:drug therapy*; D054714:Echinocandins / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic
D000935:Antifungal Agents; D054714:Echinocandins