Jarque Isidro, Angel Sanz Miguel
Hospital Universitario La Fe, Valencia, España.
Rev Iberoam Micol. 2009 Mar 31;26(1):75-7. doi: 10.1016/S1130-1406(09)70013-0. Epub 2009 May 7.
Invasive candidiasis is a severe infection among onco-hematological patients, with an attributable mortality around 40%. Micafungin has shown efficacy in antifungal prophylaxis among hematopoietic stem cell transplant recipients and in the treatment of esophageal candidiasis.
To assess the role of micafungin in the treatment of invasive candidiasis among onco-hematological patients.
Literature review.
In a study on 126 patients with candidemia treated with micafungin, an overall response rate of 83% was reported. A double-blind study of 531 patients with invasive candidiasis comparing micafungin (100mg/day) versus liposomal amphotericin B (3mg/kg/day) reported success in 90% of patients in both arms, with a more favorable safety profile with micafungin. Other double blind randomized, phase III study compared two doses of micafungin (100mg/day and 150mg/day) with standard doses of caspofungin (70mg loading dose, then 50mg/day) in adults with invasive candidiasis. Overall success rate was 74% for micafungin 100mg/day, 70% for micafungin 150mg/day, and 71% for caspofungin. A double blind randomized study compared micafungin (2mg/kg/day) to liposomal amphotericin B (3mg/kg/day) in the treatment of invasive candidiasis in children with a predominance of infections with non-albicans Candida spp. Overall success rate was similar (73% for micafungin and 76% for liposomal amphotericin B).
Comparative phase III studies have demonstrated non-inferiority of micafungin compared to standard antifungal agents for invasive candidiasis. Micafungin is safe and effective in the treatment of children and adults with invasive candidiasis. Effectivity in invasive infections caused by non-albicans Candida spp is especially relevant in onco-hematological patients receiving fluconazole prophylaxis.
侵袭性念珠菌病是肿瘤血液科患者中的一种严重感染，其归因死亡率约为40%。米卡芬净已显示出在造血干细胞移植受者的抗真菌预防以及食管念珠菌病治疗中的疗效。
评估米卡芬净在肿瘤血液科患者侵袭性念珠菌病治疗中的作用。
文献综述。
在一项对126例接受米卡芬净治疗的念珠菌血症患者的研究中，报告的总体缓解率为83%。一项对531例侵袭性念珠菌病患者进行的双盲研究比较了米卡芬净（100mg/天）与脂质体两性霉素B（3mg/kg/天），结果显示两组患者的成功率均为90%，米卡芬净的安全性更佳。另一项双盲随机III期研究比较了两种剂量的米卡芬净（100mg/天和150mg/天）与标准剂量的卡泊芬净（70mg负荷剂量，然后50mg/天）在成人侵袭性念珠菌病患者中的疗效。米卡芬净100mg/天组的总体成功率为74%，米卡芬净150mg/天组为70%，卡泊芬净组为71%。一项双盲随机研究比较了米卡芬净（2mg/kg/天）与脂质体两性霉素B（3mg/kg/天）在主要为非白色念珠菌感染的儿童侵袭性念珠菌病治疗中的疗效。总体成功率相似（米卡芬净为73%，脂质体两性霉素B为76%）。
比较性III期研究已证明米卡芬净在侵袭性念珠菌病治疗中与标准抗真菌药物相比具有非劣效性。米卡芬净在治疗侵袭性念珠菌病的儿童和成人患者中安全有效。在接受氟康唑预防的肿瘤血液科患者中，米卡芬净对非白色念珠菌引起的侵袭性感染的有效性尤为重要。
