Efficacy of micafungin for treatment of invasive candidiasis and candidaemia in patients with neutropenia

Abstract

Background

Neutropenia is linked to development of invasive candidiasis/candidaemia, for which micafungin has demonstrated efficacy, but evidence in patients with neutropenia is limited.

Objectives

Evaluate efficacy of micafungin for treatment of invasive candidiasis/candidaemia in patients with neutropenia (<500 neutrophils/μL) and without neutropenia.

Methods

This pooled, post hoc analysis of two Phase 3 trials compared micafungin 100mg/day (adults) and 2mg/kg/day (paediatrics) with L-AmB 3mg/kg/day (NCT00106288) and micafungin 100mg/day and 150mg/day with caspofungin 70mg/day followed by 50mg/day (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.

Results

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.

Conclusions

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.

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