title: Comparison of micafungin and voriconazole as empirical antifungal therapies in febrile neutropenic patients with hematological disorders: a randomized controlled trial.
abstract: OBJECTIVE
  In cases of hematological malignancy, patients with persistent fever and neutropenia receive antifungal empirical therapy to prevent and treat invasive fungal infections. The clinical efficacy and safety of micafungin and voriconazole were compared.
  
  
  METHODS
  In this randomized, cooperative group, open-label trial, we assessed and compared the efficacy and safety of micafungin and voriconazole as an empirical antifungal therapy in febrile neutropenic patients with hematological malignancy. Patients were classified according to invasive fungal infection risk.
  
  
  RESULTS
  There were no significant differences in clinical efficacy between the two treatments, evaluated based on (i) successful treatment of baseline fungal infection (no evaluation), (ii) absence of breakthrough fungal infection (P = 0.106), (iii) survival for ≥7 days after study completion (P = 0.335), (iv) premature study discontinuation due to poor efficacy (P = 0.424), and (v) resolution of fever during neutropenia (P = 0.756). Discontinuation due to drug-related adverse events (grades 3-4) occurred less frequently in the micafungin group (P = 0.005).
  
  
  CONCLUSIONS
  The clinical efficacy did not differ between micafungin and voriconazole. Micafungin was generally better tolerated than voriconazole when given as an empirical antifungal therapy in patients with persistent fever and neutropenia.
authors.affiliation: Department of Hematology and Oncology, Internal Medicine, Iwate Medical University School of Medicine, Morioka City, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Oyake
authors.affiliation: Department of Hematology and Oncology, Internal Medicine, Iwate Medical University School of Medicine, Morioka City, Japan.
authors.forename: Shugo
authors.initials: S
authors.lastname: Kowata
authors.affiliation: Department of Hematology and Oncology, Internal Medicine, Iwate Medical University School of Medicine, Morioka City, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Murai
authors.affiliation: Department of Hematology and Oncology, Internal Medicine, Iwate Medical University School of Medicine, Morioka City, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Hematology, Aomori Prefectural Central Hospital, Aomori City, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Akagi
authors.affiliation: Department of Hematology, Aomori Prefectural Central Hospital, Aomori City, Japan.
authors.forename: Kohmei
authors.initials: K
authors.lastname: Kubo
authors.affiliation: Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, Akita City, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sawada
authors.affiliation: Department of Hematology and Oncology, Internal Medicine, Iwate Medical University School of Medicine, Morioka City, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Ishida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D054714:Echinocandins / Q000627:therapeutic use*; D064147:Febrile Neutropenia / Q000150:complications* / Q000209:etiology*; D005260:Female; D006402:Hematologic Diseases / Q000150:complications* / Q000628:therapy; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy; D006801:Humans; D055666:Lipopeptides / Q000627:therapeutic use*; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D065819:Voriconazole; D000077551:Micafungin
keywords: empirical antifungal therapy; febrile neutropenia; hematological malignancies; micafungin; voriconazole