Shibata Yuichi, Hagihara Mao, Kato Hideo, Kawasumi Noriyo, Hirai Jun, Nishiyama Naoya, Asai Nobuhiro, Koizumi Yusuke, Yamagishi Yuka, Matsuura Katsuhiko, Mikamo Hiroshige
Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Pharmacy, Aichi Medical University Hospital, Japan.
Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
J Infect Chemother. 2017 Jun;23(6):349-353. doi: 10.1016/j.jiac.2017.02.008. Epub 2017 Apr 18.
One of the major adverse events of caspofungin and micafungin is hepatotoxicity, however, there are few reports compared the incidence of hepatotoxicity between caspofungin and micafungin. Herein, the primary objective of this study was to compare the incidence of hepatotoxicity between caspofungin and micafungin treatments for patients with fungal or suspected fungal infection.
In total, 201 patients [caspofungin group: 66 patients; micafungin group: 135 patients] treated with echinocandins from April 2014 to November 2015 at Aichi Medical University Hospital. Investigation item were as follows; sex, age, weight, height, duration of treatment, total dose, disease type, clinical isolates, liver enzyme levels, concomitant medications. Liver function was assessed in accordance with Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. We divided into two groups depend on their liver enzyme levels before treated with echinocandins; normal group (liver enzyme levels ≤ CTCAE Grade 1), abnormal group (liver enzyme levels ≥ CTCAE Grade 2).
The overall incidence of serious hepatotoxicity (Grade 3 or higher) was 6.1% (4/66) in the caspofungin group and 7.4% (10/135) in the micafungin group. The proportion of patients used caspofungin and micafungin showed serious hepatotoxicity were 0% (0/47) and 6.5% (7/108) in normal group (p = 0.17), and 21.1% (4/19) and 10.7% (3/28) in abnormal group (p = 0.42).
There was no notable difference in serious hepatotoxicity between the caspofungin group and the micafungin group, even though in patients with abnormal liver enzyme levels (CTCAE grade 2 or higher).
卡泊芬净和米卡芬净的主要不良事件之一是肝毒性，然而，比较卡泊芬净和米卡芬净肝毒性发生率的报道很少。在此，本研究的主要目的是比较卡泊芬净和米卡芬净治疗真菌或疑似真菌感染患者时肝毒性的发生率。
2014年4月至2015年11月期间，共有201例接受棘白菌素治疗的患者[卡泊芬净组：66例患者；米卡芬净组：135例患者]在爱知医科大学医院接受治疗。调查项目如下：性别、年龄、体重、身高、治疗持续时间、总剂量、疾病类型、临床分离株、肝酶水平、合并用药。根据不良事件通用术语标准（CTCAE）第4.0版评估肝功能。在使用棘白菌素治疗前，根据肝酶水平将患者分为两组；正常组（肝酶水平≤CTCAE 1级），异常组（肝酶水平≥CTCAE 2级）。
卡泊芬净组严重肝毒性（3级或更高）的总体发生率为6.1%（4/66），米卡芬净组为7.4%（10/135）。正常组中使用卡泊芬净和米卡芬净出现严重肝毒性的患者比例分别为0%（0/47）和6.5%（7/108）（p = 0.17），异常组中分别为21.1%（4/19）和10.7%（3/28）（p = 0.42）。
卡泊芬净组和米卡芬净组之间在严重肝毒性方面没有显著差异，即使是在肝酶水平异常（CTCAE 2级或更高）的患者中。
