Infect Chemother.  2010 Jun;42(3):149-155. 10.3947/ic.2010.42.3.149.

Efficacy and Safety of Micafungin for Prophylaxis of Invasive Fungal Infection in Hematopoietic Stem Cell Transplantation Recipients

• Kim SH
• Lee DG
• Choi SM
• Kwon JC
• Park SH
• Choi JH
• Yoo JH
• Lee SE
• Cho BS
• Kim YJ
• Lee S
• Kim HJ
• Min CK
• Cho SG
• Kim DW
• Lee JW
• Min WS
• Park JW

• KMID: 2170302
• DOI: http://doi.org/10.3947/ic.2010.42.3.149

Abstract

BACKGROUND
Micafungin, a potent inhibitor of 1,3-beta-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking.
MATERIALS AND METHODS
We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs.
RESULTS
The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin.
CONCLUSIONS
Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

Keyword

Hematopoietic stem cell transplantation; Micafungin; Mycoses; Prophylaxis

MeSH Terms

Adult
Alanine Transaminase
Antifungal Agents
Aspartate Aminotransferases
Aspergillosis
Aspergillus
Candida
Candidiasis
Candidiasis, Invasive
Diarrhea
Echinocandins
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Hypokalemia
Invasive Pulmonary Aspergillosis
Itraconazole
Lipopeptides
Medical Records
Mycoses
Neutropenia
Retrospective Studies
Siblings
Sinusitis
Vomiting
Alanine Transaminase
Antifungal Agents
Aspartate Aminotransferases
Echinocandins
Itraconazole
Lipopeptides

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