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1 October 2007

Volume 45, Number 7
Clinical Infectious Diseases 2007;45:883–893
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4507-0011$15.00
DOI: 10.1086/520980
MAJOR ARTICLE

Micafungin versus Caspofungin for Treatment of Candidemia and Other Forms of Invasive Candidiasis

Peter G. Pappas,1

Coleman M. F. Rotstein,9

Robert F. Betts,2

Marcio Nucci,10

Deepak Talwar,11

Jan J. De Waele,13

Jose A. Vazquez,3

Bertrand F. Dupont,14

David L. Horn,4

Luis Ostrosky‐Zeichner,6

Annette C. Reboli,7

Byungse Suh,5

Raghunadharao Digumarti,12

Chunzhang Wu,8

Laura L. Kovanda,8

Leah J. Arnold,8 and

Donald N. Buell8

1University of Alabama at Birmingham; 2University of Rochester, Rochester, New York; 3Henry Ford Health System, Detroit, Michigan; 4Thomas Jefferson University and 5Temple University, Philadelphia, Pennsylvania; 6University of Texas‐Houston; 7Cooper University Hospital, Camden, New Jersey; 8Astellas Pharma US, Deerfield, Illinois; 9Hamilton Health Sciences, Hamilton, Canada; 10Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil; 11Metro Hospitals and Heart Institute, Uttar Pradesh, and 12Nizam Institute of Medical Sciences, Hyderabad, India; 13Ghent University Hospital, Ghent, Belgium; and 14Hôpital Necker, Paris, France

Background.Invasive candidiasis is an important cause of morbidity and mortality among patients with health care–associated infection. The echinocandins have potent fungicidal activity against most Candida species, but there are few data comparing the safety and efficacy of echinocandins in the treatment of invasive candidiasis.

Methods.This was an international, randomized, double‐blind trial comparing micafungin (100 mg daily) and micafungin (150 mg daily) with a standard dosage of caspofungin (70 mg followed by 50 mg daily) in adults with candidemia and other forms of invasive candidiasis. The primary end point was treatment success, defined as clinical and mycological success at the end of blinded intravenous therapy.

Results.A total of 595 patients were randomized to one the treatment groups and received at least 1 dose of study drug. In the modified intent‐to‐treat population, 191 patients were assigned to the micafungin 100 mg group, 199 to the micafungin 150 mg group, and 188 to the caspofungin group. Demographic characteristics and underlying disorders were comparable across the groups. Approximately 85% of patients had candidemia; the remainder had noncandidemic invasive candidiasis. At the end of blinded intravenous therapy, treatment was considered successful for 76.4% of patients in the micafungin 100 mg group, 71.4% in the micafungin 150 mg group, and 72.3% in the caspofungin group. The median time to culture negativity was 2 days in the micafungin 100 mg group and the caspofungin group, compared with 3 days in the micafungin 150 mg groups. There were no significant differences in mortality, relapsing and emergent infections, or adverse events between the study arms.

Conclusions.Dosages of micafungin 100 mg daily and 150 mg daily were noninferior to a standard dosage of caspofungin for the treatment of candidemia and other forms of invasive candidiasis.

Received 26 March 2007; accepted 12 June 2007; electronically published 29 August 2007.

Reprints or correspondence: Dr. Peter G. Pappas, Div. of Infectious Diseases, University of Alabama at Birmingham, 1900 University Blvd., THT 229, Birmingham, AL 35294‐0006 (); Dr. Coleman M. F. Rotstein, McMaster University, 711 Concession St., Mailton, ON L8V 1C3 ().

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