[Micafungin in invasive candidiasis among oncohematological patients].

BACKGROUND: 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.

AIMS: To assess the role of micafungin in the treatment of invasive candidiasis among onco-hematological patients.

METHODS: Literature review.

RESULTS: 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).

CONCLUSIONS: 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.