Micafungin for the treatment of invasive aspergillosis.
Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients, particularly those with neutropenia and those undergoing bone marrow or stem cell transplants. Micafungin is an echinocandin antifungal drug with activity against all major Candida spp. Currently, micafungin is indicated for treatment of invasive candidiasis, oesophageal candidiasis and prophylaxis of Candida infection in patients undergoing allogeneic haematopoietic stem cell transplantation or patients who are expected to have neutropenia. Micafungin demonstrates in vitro and in vivo activity against Aspergillus spp. It is currently not licensed to treat Aspergillus infections in the UK or USA. This review summarises the current evidence base surrounding the clinical use of micafungin in the treatment of invasive aspergillosis to consider the potential role of micafungin in these patients. There are currently no randomised studies comparing micafungin with standard antifungal therapy. Prospective non-randomised clinical studies, predominantly performed in Japan, involving 492 patients with aspergillosis and 455 febrile patients with chemotherapy-induced neutropenia suggest that micafungin may be as effective as comparator antifungal agents. Other clinical evidence is limited to case reports. Further experience in the form of randomised controlled trials is required to establish the exact role of micafungin in the context of currently available broad-spectrum antifungal agents.
Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrookes Hospital, Cambridge CB2 2QW, UK. Electronic address: david.enoch@addenbrookes.nhs.uk.
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Enoch
Department of Haematology, Addenbrookes Hospital, Cambridge CB2 2QW, UK.
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Idris
Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrookes Hospital, Cambridge CB2 2QW, UK.
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Aliyu
Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrookes Hospital, Cambridge CB2 2QW, UK.
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Micallef
Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrookes Hospital, Cambridge CB2 2QW, UK.
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Sule
Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrookes Hospital, Cambridge CB2 2QW, UK.
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Karas
D000935:Antifungal Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D054714:Echinocandins / Q000627:therapeutic use*; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy*; D055666:Lipopeptides / Q000627:therapeutic use*; D000077551:Micafungin; D011446:Prospective Studies; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin
Antifungal agents; Aspergillus spp.; Invasive aspergillosis; Micafungin