Authors' objectives:

The aim of this study is to assess the evidence that there is on the clinical effectiveness of caspofungin in mycotic infections as well as its safety profile, toxicity and costs.

Authors' results and conclusions: Six clinical randomized trials comparing caspofungin and amphotericin B (5) or fluconazole (1) were included. One of them compares caspofungin against liposomal amphotericin B in cases of febrile neutropenia with suspected mycosis, showing similar efficacy with fewer side effects such as nephrotoxicity (2,6% vs. 11,5%), infusion related events (35,1% vs. 51,6%) and discontinuation due to side effects (5% vs. 8%). Three studies evaluated caspofungin use for esophageal candidiasis: two of them compare it against amphotericin B, observing a similar treatment response (about 80%) and a lower incidence of side effects (only one of the studies reports these findings); a third study compares casponfungin with fluconazole, but no differences were found. Two studies assessed the effect of caspofungin on systemic candidiasis against amphotericin B. Differences in efficacy and overall mortality were not found in any of them; and one showed a lower incidence of side effects (the other does not report this finding). It is also important to mention one series of 90 cases which evaluated the use of casponfungin in refractory invasive aspergillosis, showing a 45% response in patients who had drug intolerance or a bad response. This study caused the United States regulatory agency (FDA) to approve this drug for this indication. This has been the only indication recommended (since 2001) by the technology evaluation performed by the Canadian agency CCOHTA and covered by the U.S. Medicare system. No randomized clinical trials including pediatric populations were found.

Authors' recommendations: Caspofungin seems to have the same efficacy as amphotericin B for the treatment of invasive mycosis caused by Candida and Aspergillus in adult immunocompromised patients; but with a better side-effect profile. However, the high cost of this drug compared with amphotericin B, taking its comparable efficacy into account, can be a limiting factor for its use in these indications. It can be a valid option for those situations in which it is thought as an alternative to liposomal amphotericin B, due to its similar effectiveness, fewer side effects and lower costs. In cases of systemic mycoses refractory to other antimycotic medications, caspofungin can be the only therapeutic alternative.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)