title: Short-term risk of liver and renal injury in hospitalized patients using micafungin: a multicentre cohort study.
abstract: Although echinocandins are generally well tolerated, there is little information on the frequency with which renal and hepatic adverse effects occur during use of micafungin or other parenteral antifungal (PAF) agents in clinical practice.
  
  
  
  MYCOS is a multicentre cohort study of adult and paediatric patients who received micafungin or other PAFs between 2005 and 2012 at seven tertiary care hospitals from six centres in the USA. PAF cohort controls were selected through propensity score (PS) matching to micafungin recipients using clinical characteristics, other treatments, procedures and hospital service where PAF treatment was initiated. Analysis was restricted to patients without chronic liver and kidney conditions at the time of cohort entry. Treatment-emergent hepatic and renal injury was documented by changes in liver enzymes or estimated glomerular filtration rate through 30 days following completion of PAF treatment. Comparisons were quantified using the HR from a proportional hazards analysis.
  
  
  
  There were 2970 micafungin recipients PS matched to 6726 recipients of comparator PAFs. Balance was achieved in all baseline covariates between treatment groups. There were similar rates of hepatic injury (micafungin, 13 events per 100 patients and other PAF, 12 per 100; HR = 0.99; 95% CI 0.86-1.14) and lower rates of renal injury (micafungin, 63 events per 100 patients and other PAF, 65 per 100; HR = 0.93; 95% CI 0.87-0.99) for micafungin recipients versus PAF comparators.
  
  
  
  For a wide spectrum of underlying conditions, we observed no increase in liver injury by micafungin and possibly a reduced risk of renal dysfunction in comparison with other PAF medications.
authors.affiliation: WHISCON, Newton, MA, USA Division of Pharmacoepidemiology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA schneeweiss@post.harvard.edu.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.affiliation: University of Michigan Medical Center, Ann Arbor, MI, USA.
authors.forename: Peggy L
authors.initials: PL
authors.lastname: Carver
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Kausik
authors.initials: K
authors.lastname: Datta
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Galar
authors.affiliation: Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Johnson
authors.affiliation: Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Johnson
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Marty
authors.affiliation: University of Michigan Medical Center, Ann Arbor, MI, USA.
authors.forename: Jerod
authors.initials: J
authors.lastname: Nagel
authors.affiliation: Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Maryann
authors.initials: M
authors.lastname: Najdzinowicz
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Saul
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Shoham
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Fernanda P
authors.initials: FP
authors.lastname: Silveira
authors.affiliation: Division of Infectious Diseases, Department of Pharmacy, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Christy A
authors.initials: CA
authors.lastname: Varughese
authors.affiliation: Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Marissa
authors.initials: M
authors.lastname: Wilck
authors.affiliation: WHISCON, Newton, MA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Weatherby
authors.affiliation: Astellas Pharma Europe, Leiden, The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Auton
authors.affiliation: WHISCON, Newton, MA, USA.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Walker
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D015331:Cohort Studies; D054714:Echinocandins / Q000008:administration & dosage / Q000009:adverse effects*; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization; D006801:Humans; D007263:Infusions, Parenteral; D055666:Lipopeptides / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D000077551:Micafungin; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D062606:Tertiary Care Centers; D014481:United States / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin