SAN FRANCISCO — Intravenous micafungin at two different doses produced cure rates similar to those with caspofungin in an international trial with 593 adults who had candidemia or invasive candidiasis, Dr. Robert Betts reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
Micafungin, a member of the class known as echinocandins, was approved in the United States in 2005 for esophageal candidiasis and prophylactic treatment of bone marrow transplant patients.
The cure rates overall were 74% for the lower dose of micafungin (100 mg/day), 70% for the more typical dose (150 mg/day), and 71% for caspofungin, which was given as a 70-mg loading dose on the first day followed by 50 mg/day.
There were no significant differences between the treatments in adverse events, treatment discontinuation, or relapse, said Dr. Betts, a professor of medicine at the University of Rochester, New York.
The only significant difference was in the treatment of patients with invasive candidiasis, for whom the lower dose of micafungin was more effective than the higher dose, with a cure rate of 75% vs. 53%. By comparison, the caspofungin cure rate was 65% for invasive candidiasis.
Some nonsignificant differences were found for species of Candida other than Candida albicans: Caspofungin performed slightly better against C. tropicalis (75% success vs. 68%), and micafungin performed better against C. glabrata (86% vs. 67%) and C. parapsilosis (77% vs. 64%). Those results may deserve further investigation, Dr. Betts said.
“Micafungin at 100 mg a day appears to be the optimal dose in the treatment of invasive candidiasis or candidemia,” he said.
The study was sponsored by Astellas Pharma, manufacturer of micafungin.