Division of Infectious Diseases, Department of Internal Medicine, Wayne State University, Karmanos Cancer Center, Detroit, MI, USA.
Barts Health NHS Trust, London, UK.
Mycoses. 2018 May;61(5):331-336. doi: 10.1111/myc.12748. Epub 2018 Feb 2.
Neutropenia is linked to the development of invasive candidiasis/candidaemia, for which micafungin has demonstrated efficacy, but evidence in patients with neutropenia is limited. The aim of this study was to evaluate the efficacy of micafungin for the treatment of invasive candidiasis/candidaemia in patients with neutropenia (<500 neutrophils/μL) and without neutropenia. This pooled, post hoc analysis of 2 Phase 3 trials compared micafungin 100 mg/d (adults) and 2 mg/kg/d (paediatrics) with L-AmB 3 mg/kg/d (NCT00106288) and micafungin 100 mg/d and 150 mg/d with caspofungin 70 mg/d followed by 50 mg/d (adults) (NCT00105144); treatment duration 2-4 weeks (≤8 weeks for chronic disseminated candidiasis). Effects of neutropenia duration and Candida spp. on efficacy outcomes (treatment success, clinical and mycological response) were examined. Of 685 patients, 77 had neutropenia. The most common infection in patients with/without neutropenia was due to C. tropicalis (31/77) and C. albicans (295/608) respectively. Overall success was numerically lower in patients with vs without neutropenia (63.6% vs 72.9%). Clinical and mycological response was similar between groups. Neutropenia duration or Candida spp. did not impact micafungin's overall success rate. This analysis supports evidence that micafungin is effective against invasive candidiasis/candidaemia in patients with neutropenia, irrespective of neutropenia duration or Candida spp., although overall success may be lower than in patients without neutropenia.
中性粒细胞减少与侵袭性念珠菌病/念珠菌血症的发生有关，米卡芬净已被证实对此具有疗效，但中性粒细胞减少患者的相关证据有限。本研究旨在评估米卡芬净治疗中性粒细胞减少（＜500 个中性粒细胞/μL）和非中性粒细胞减少患者侵袭性念珠菌病/念珠菌血症的疗效。这是两项 3 期临床试验的事后汇总分析，比较了米卡芬净 100mg/d（成人）和 2mg/kg/d（儿科）与两性霉素 B 3mg/kg/d（NCT00106288）以及米卡芬净 100mg/d 和 150mg/d 与卡泊芬净 70mg/d 序贯 50mg/d（成人）（NCT00105144）的疗效；治疗持续时间为 2-4 周（慢性播散性念珠菌病≤8 周）。研究还评估了中性粒细胞减少持续时间和念珠菌属对疗效结果（治疗成功、临床和微生物学应答）的影响。在 685 例患者中，77 例存在中性粒细胞减少。有/无中性粒细胞减少患者最常见的感染分别是热带念珠菌（31/77）和白念珠菌（295/608）引起的。与无中性粒细胞减少患者相比，中性粒细胞减少患者的总体成功率较低（63.6% vs 72.9%）。两组的临床和微生物学应答相似。中性粒细胞减少持续时间或念珠菌属均未影响米卡芬净的总体成功率。该分析支持米卡芬净对中性粒细胞减少患者侵袭性念珠菌病/念珠菌血症有效的证据，无论中性粒细胞减少持续时间或念珠菌属如何，尽管总体成功率可能低于无中性粒细胞减少患者。
