Comparison of caspofungin and amphotericin B for invasive candidiasis.

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dc.contributor.author Mora-Duarte, J.
dc.contributor.author Betts, R.
dc.contributor.author Rotstein, C.
dc.contributor.author Colombo, A. L.
dc.contributor.author Thompson-Moya, L.
dc.contributor.author Smietana, J.
dc.contributor.author Lupinacci, R.
dc.contributor.author Sable, C.
dc.contributor.author Kartsonis, N.
dc.contributor.author Perfect, J.
dc.contributor.author Caspofungin Invasive Candidiasis S
dc.date.accessioned 2016-01-24T12:33:38Z
dc.date.available 2016-01-24T12:33:38Z
dc.date.issued 2002-12-19
dc.identifier http://dx.doi.org/10.1056/NEJMoa021585
dc.identifier.citation New England Journal of Medicine. Waltham: Massachusetts Medical Soc/nejm, v. 347, n. 25, p. 2020-2029, 2002.
dc.identifier.issn 0028-4793
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/27073
dc.description.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. en
dc.format.extent 2020-2029
dc.language.iso eng
dc.publisher Massachusetts Medical Soc/nejm
dc.relation.ispartof New England Journal of Medicine
dc.rights Acesso restrito
dc.title Comparison of caspofungin and amphotericin B for invasive candidiasis. en
dc.type Artigo
dc.contributor.institution CCSS
dc.contributor.institution Univ Rochester
dc.contributor.institution McMaster Univ
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Clin Santa Maria
dc.contributor.institution Merck Res Labs
dc.description.affiliation CCSS, Neeman ICIC & Hosp Mexico, San Jose, Costa Rica
dc.description.affiliation Univ Rochester, Rochester, NY USA
dc.description.affiliation McMaster Univ, Hamilton, ON, Canada
dc.description.affiliation UNIFESP, Escola Paulista Med, São Paulo, Brazil
dc.description.affiliation Clin Santa Maria, Santiago, Chile
dc.description.affiliation Merck Res Labs, W Point, PA USA
dc.description.affiliationUnifesp UNIFESP, Escola Paulista Med, São Paulo, Brazil
dc.identifier.doi 10.1056/NEJMoa021585
dc.description.source Web of Science
dc.identifier.wos WOS:000179874500005



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