Comparison of caspofungin and amphotericin B for invasive candidiasis.

Comparison of caspofungin and amphotericin B for invasive candidiasis.

Author Mora-Duarte, J. Google Scholar
Betts, R. Google Scholar
Rotstein, C. Google Scholar
Colombo, A. L. Google Scholar
Thompson-Moya, L. Google Scholar
Smietana, J. Google Scholar
Lupinacci, R. Google Scholar
Sable, C. Google Scholar
Kartsonis, N. Google Scholar
Perfect, J. Google Scholar
Caspofungin Invasive Candidiasis S Google Scholar
Institution CCSS
Univ Rochester
McMaster Univ
Universidade Federal de São Paulo (UNIFESP)
Clin Santa Maria
Merck Res Labs
Abstract Background: Caspofungin is an echinocandin agent with fungicidal activity against candida species. We performed a double-blind trial to compare caspofungin with amphotericin B deoxycholate for the primary treatment of invasive candidiasis.Methods: We enrolled patients who had clinical evidence of infection and a positive culture for candida species from blood or another site. Patients were stratified according to the severity of disease, as indicated by the Acute Physiology and Chronic Health Evaluation (APACHE II) score, and the presence or absence of neutropenia and were randomly assigned to receive either caspofungin or amphotericin B. the study was designed to compare the efficacy of caspofungin with that of amphotericin B in patients with invasive candidiasis and in a subgroup with candidemia.Results: of the 239 patients enrolled, 224 were included in the modified intention-to-treat analysis. Base-line characteristics, including the percentage of patients with neutropenia and the mean APACHE II score, were similar in the two treatment groups. A modified intention-to-treat analysis showed that the efficacy of caspofungin was similar to that of amphotericin B, with successful outcomes in 73.4 percent of the patients treated with caspofungin and in 61.7 percent of those treated with amphotericin B (difference after adjustment for APACHE II score and neutropenic status, 12.7 percentage points; 95.6 percent confidence interval, -0.7 to 26.0). An analysis of patients who met prespecified criteria for evaluation showed that caspofungin was superior, with a favorable response in 80.7 percent of patients, as compared with 64.9 percent of those who received amphotericin B (difference, 15.4 percentage points; 95.6 percent confidence interval, 1.1 to 29.7). Caspofungin was as effective as amphotericin B in patients who had candidemia, with a favorable response in 71.7 percent and 62.8 percent of patients, respectively (difference, 10.0 percentage points; 95.0 percent confidence interval, -4.5 to 24.5). There were significantly fewer drug-related adverse events in the caspofungin group than in the amphotericin B group.Conclusions: Caspofungin is at least as effective as amphotericin B for the treatment of invasive candidiasis and, more specifically, candidemia.
Language English
Date 2002-12-19
Published in New England Journal of Medicine. Waltham: Massachusetts Medical Soc/nejm, v. 347, n. 25, p. 2020-2029, 2002.
ISSN 0028-4793 (Sherpa/Romeo, impact factor)
Publisher Massachusetts Medical Soc/nejm
Extent 2020-2029
Origin http://dx.doi.org/10.1056/NEJMoa021585
Access rights Closed access
Type Article
Web of Science ID WOS:000179874500005
URI http://repositorio.unifesp.br/handle/11600/27073

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