Falagas Matthew E, Ntziora Fotinie, Betsi Gregoria I, Samonis George
Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Athens, Greece.
Int J Antimicrob Agents. 2007 Feb;29(2):136-43. doi: 10.1016/j.ijantimicag.2006.09.018. Epub 2007 Jan 4.
During the last decade, owing to the low effectiveness and high toxicity of older antifungals, new antifungal agents have been released to the market for the treatment of patients with fungal infections. Several randomized controlled trials (RCTs) have been designed to evaluate the effectiveness of caspofungin in comparison with other antifungal agents. This review was conducted to examine further the role of caspofungin in the treatment of patients with fungal, mainly Candida, infections. Two reviewers independently performed the literature search, study selection and data extraction from relevant RCTs. A total of six RCTs comparing caspofungin with amphotericin B (deoxycholate in four and liposomal in one RCT) or fluconazole (in one RCT), which studied a total of 1974 patients, were included in our review. Success of the applied treatment in the clinically evaluable patients was achieved in 496/943 (52.6%) of the caspofungin-treated patients and in 381/852 (44.7%) of the amphotericin B- and lipid amphotericin B-treated patients. Discontinuation due to drug toxicity was significantly less common in patients receiving caspofungin than amphotericin B (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.07-0.85, random effects model). Development of nephrotoxicity, hypokalaemia and fever also occurred significantly less often with caspofungin than amphotericin B (OR 0.23, 95% CI 0.14-0.36, fixed effects model; OR 0.3, 95% CI 0.12-0.76, random effects model; and OR 0.26, 95% CI 0.08-0.79, random effects model, respectively). No difference in mortality was noted. Caspofungin was associated with better clinical outcomes (higher cure and fewer adverse effects) than amphotericin B in the treatment of patients with fungal infections.
在过去十年中，由于旧的抗真菌药物疗效低且毒性高，新的抗真菌药物已投放市场用于治疗真菌感染患者。已经设计了几项随机对照试验（RCT）来评估卡泊芬净与其他抗真菌药物相比的有效性。进行这项综述是为了进一步研究卡泊芬净在治疗真菌（主要是念珠菌）感染患者中的作用。两名评价者独立进行文献检索、研究选择和从相关RCT中提取数据。我们的综述纳入了总共六项将卡泊芬净与两性霉素B（四项RCT中为去氧胆酸盐，一项RCT中为脂质体）或氟康唑（一项RCT）进行比较的RCT，这些研究共涉及1974例患者。在可进行临床评估的患者中，接受卡泊芬净治疗的患者有496/943（52.6%）治疗成功，接受两性霉素B和脂质体两性霉素B治疗的患者有381/852（44.7%）治疗成功。因药物毒性而停药在接受卡泊芬净治疗的患者中明显少于接受两性霉素B治疗的患者（优势比（OR）0.25，95%置信区间（CI）0.07 - 0.85，随机效应模型）。卡泊芬净治疗时肾毒性、低钾血症和发热的发生也明显少于两性霉素B（分别为OR 0.23，95% CI 0.14 - 0.36，固定效应模型；OR 0.3，95% CI 0.12 - （此处原文有误，应为0.76），随机效应模型；OR 0.26，95% CI 0.08 - 0.79，随机效应模型）。未观察到死亡率有差异。在治疗真菌感染患者方面，卡泊芬净比两性霉素B具有更好的临床结局（治愈率更高且不良反应更少）。
