Efficacy and Tolerability of Micafungin Monotherapy for Candidemia and Deep-Seated Candidiasis in Adults with Cancer

Farmakiotis, Dimitrios; Tarrand, Jeffrey J.; Kontoyiannis, Dimitrios P.

doi:10.1128/aac.00051-14

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…In patients with invasive fungal infections the recommended length of therapy is 14 days after the first negative blood culture [ 9 , 24 ], which is in line with the observed median length of treatment of 12–14 days in this study. The overall response rates in this study are comparable to those found in other performed studies [ 11 , 32 ]. The overall response rate of micafungin is comparable to that of anidulafungin.…”

Section: Discussionsupporting

confidence: 90%

Micafungin versus anidulafungin in critically ill patients with invasive candidiasis: a retrospective study

et al. 2016

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BackgroundIn critically ill patients the incidence of invasive fungal infections caused by Candida spp. has increased remarkably. Echinocandins are recommended as initial treatment for invasive fungal infections. The safety and efficacy of micafungin compared to caspofungin is similar, but no comparison is made between anidulafungin and micafungin concerning safety and efficacy. We therefore performed a retrospective study to assess these aspects in critically ill patients with invasive candidiasis.MethodsAll patients in the intensive care unit (ICU) with invasive candidiasis, who were only treated with anidulafungin or micafungin, between January 2012 and December 2014 were retrospectively included. Baseline demographic characteristics, infection characteristics and patient courses were assessed.ResultsA total of 63 patients received either anidulafungin (n = 30) or micafungin (n = 33) at the discretion of the attending intensivist. Baseline characteristics were comparable between the two groups, suggesting similar risk for developing invasive candidiasis. Patients with invasive candidiasis and liver failure were more often treated with anidulafungin than micafungin. Response rates were similar for both groups. No difference was observed in 28-day mortality, but 90-day mortality was higher in patients on anidulafungin. Multivariable cox regression analysis showed that age and serum bilirubin were the best parameters for the prediction of 90-day mortality, whereas APACHE II, Candida score and antifungal therapy did not contribute (P > 0.05). None of the patients developed impaired liver function related to antifungal use and no differences were seen in prothrombin time, serum transaminases and bilirubin levels between the groups, after exclusion of patients with liver injury or failure.ConclusionMicafungin can be safely and effectively used in critically ill patients with invasive candidiasis. The observed increased 90-day mortality with anidulafungin can be explained by intensivists unnecessarily avoiding micafungin in patients with liver injury and failure.

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Section: Discussionsupporting

confidence: 90%

Micafungin versus anidulafungin in critically ill patients with invasive candidiasis: a retrospective study

et al. 2016

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“…Candidemia and IFIs are major complications in patients with HMs who develop prolonged and severe neutropenia. Additionally, IFIs are difficult to diagnose in these severely immunocompromised patients [88][89][90][91]. In patients with MM prior to the introduction of novel therapies, IFIs were encountered in patients treated with traditional intensive cytotoxic chemotherapeutic regimens and mortality rates due to IFIs were reaching 60% [91].…”

Section: Fungal Infections In MMmentioning

confidence: 99%

“…Over the past two decades, the spectrum of Candida species infections has shifted to non-albicans species, which frequently exhibit decreased susceptibility to fluconazole [89]. Empirical antifungal agents are recommended in patients with HMs having neutropenia and persistent or recurrent fever despite appropriate antibiotic therapy [88].…”

Section: Fungal Infections In MMmentioning

confidence: 99%

“…Empirical antifungal agents are recommended in patients with HMs having neutropenia and persistent or recurrent fever despite appropriate antibiotic therapy [88]. In patients with candidemia or invasive infection caused by Candida species, echinocandins such as caspofungin, liposomal amphotericin-B, and voriconazole are the treatments of choice, while voriconazole is the treatment of choice for IFIs caused by Aspergillus species [67,89,90,92]. However, fluconazole is still the most common antifungal agent used for prophylaxis in HR patients and in recipients of HSCT [91,92].…”

Section: Fungal Infections In MMmentioning

confidence: 99%

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Infections in Patients with Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies

Al-Jasser¹,

Al-Anazi²

2019

Update on Multiple Myeloma

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Multiple myeloma is a common hematologic malignancy that is associated with reduced cellular as well as humoral immunity ultimately causing various infectious complications. The recent advances in the management of myeloma have led not only to prolonged survival but also to shifts in the incidence as well as the spectrum of infections encountered. This book chapter will be an updated review on the infectious complications in patients with multiple myeloma in the era of novel agents, stem cell therapies, and monoclonal antibodies. It will cover causes of immunosuppression, timing, and types as well as management of the various infections reported with various therapeutic modalities that are currently utilized in the management of myeloma patients.

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“…Echinocandins, which inhibit cell wall glucan synthesis, were a major development in antifungal therapy. In addition to the enhanced spectrum of echinocandins over that of triazole therapy, studies have demonstrated the efficacy of echinocandins for the prevention and treatment of invasive candidiasis (3,(6)(7)(8)(9)(10)(11)(12). Echinocandins also are associated with a very low incidence of adverse effects and have an excellent safety profile.…”

mentioning

confidence: 99%

Pharmacodynamics of a Long-Acting Echinocandin, CD101, in a Neutropenic Invasive-Candidiasis Murine Model Using an Extended-Interval Dosing Design

Lepak

Zhao

VanScoy

et al. 2018

Antimicrob Agents Chemother

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Echinocandins are important in the prevention and treatment of invasive candidiasis but limited by current dosing regimens that include daily intravenous administration. The novel echinocandin CD101 has a prolonged half-life of approximately 130 h in humans, making it possible to design once-weekly dosing strategies. The present study examined the pharmacodynamic activity of CD101 using the neutropenic invasive candidiasis mouse model against select ( = 4), ( = 3), and ( = 3) strains. The CD101 MIC ranged from 0.03 to 1 mg/liter. Plasma pharmacokinetic measurements were performed using uninfected mice after intraperitoneal administration of 1, 4, 16, and 64 mg/kg. The elimination half-life was prolonged at 28 to 41 h. Neutropenic mice were infected with each strain by lateral tail vein injection, treated with a single dose of CD101, and monitored for 7 days, at which time the organism burden was enumerated from the kidneys. Dose-dependent activity was observed for each organism. The pharmacokinetic/pharmacodynamic (PK/PD) index of the area under the concentration-time curve over 24 h in the steady state divided by the MIC (AUC/MIC index) correlated well with efficacy (, 0.74 to 0.93). The median stasis 24-h free-drug AUC/MIC targets were as follows: for , 2.92; for, 0.07; and for , 2.61. The PK/PD targets for 1-log kill endpoint were 2- to 4-fold higher. Interestingly, the aforementioned PK/PD targets of CD101 were numerically lower for all three species than those of other echinocandins. In summary, CD101 is a promising, novel echinocandin with advantageous pharmacokinetic properties and potent pharmacodynamic activity.

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Efficacy and Tolerability of Micafungin Monotherapy for Candidemia and Deep-Seated Candidiasis in Adults with Cancer

Cited by 8 publications

References 15 publications

Micafungin versus anidulafungin in critically ill patients with invasive candidiasis: a retrospective study

Micafungin versus anidulafungin in critically ill patients with invasive candidiasis: a retrospective study

Infections in Patients with Multiple Myeloma in the Era of Novel Agents and Stem Cell Therapies

Pharmacodynamics of a Long-Acting Echinocandin, CD101, in a Neutropenic Invasive-Candidiasis Murine Model Using an Extended-Interval Dosing Design

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