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Comparison of micafungin and voriconazole as empirical antifungal therapies in febrile neutropenic patients with hematological disorders: a randomized controlled trial
Author(s) -
Oyake Tatsuo,
Kowata Shugo,
Murai Kazunori,
Ito Shigeki,
Akagi Tomoaki,
Kubo Kohmei,
Sawada Kenichi,
Ishida Yoji
Publication year - 2016
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12641
Subject(s) - micafungin , voriconazole , neutropenia , medicine , discontinuation , febrile neutropenia , adverse effect , echinocandin , randomized controlled trial , amphotericin b deoxycholate , gastroenterology , intensive care medicine , caspofungin , chemotherapy , antifungal , fluconazole , dermatology
Objectives In cases of hematological malignancy, patients with persistent fever and neutropenia receive antifungal empirical therapy to prevent and treat invasive fungal infections. The clinical efficacy and safety of micafungin and voriconazole were compared. Methods In this randomized, cooperative group, open‐label trial, we assessed and compared the efficacy and safety of micafungin and voriconazole as an empirical antifungal therapy in febrile neutropenic patients with hematological malignancy. Patients were classified according to invasive fungal infection risk. Results There were no significant differences in clinical efficacy between the two treatments, evaluated based on (i) successful treatment of baseline fungal infection (no evaluation), (ii) absence of breakthrough fungal infection ( P = 0.106), (iii) survival for ≥7 days after study completion ( P = 0.335), (iv) premature study discontinuation due to poor efficacy ( P = 0.424), and (v) resolution of fever during neutropenia ( P = 0.756). Discontinuation due to drug‐related adverse events (grades 3‐4) occurred less frequently in the micafungin group ( P = 0.005). Conclusions The clinical efficacy did not differ between micafungin and voriconazole. Micafungin was generally better tolerated than voriconazole when given as an empirical antifungal therapy in patients with persistent fever and neutropenia.