Document Detail

Caspofungin for the treatment of fungal infections: a systematic review of randomized controlled trials.
MedLine Citation:
PMID:  17207609     Owner:  NLM     Status:  MEDLINE    
During the last decade, owing to the low effectiveness and high toxicity of older antifungals, new antifungal agents have been released to the market for the treatment of patients with fungal infections. Several randomized controlled trials (RCTs) have been designed to evaluate the effectiveness of caspofungin in comparison with other antifungal agents. This review was conducted to examine further the role of caspofungin in the treatment of patients with fungal, mainly Candida, infections. Two reviewers independently performed the literature search, study selection and data extraction from relevant RCTs. A total of six RCTs comparing caspofungin with amphotericin B (deoxycholate in four and liposomal in one RCT) or fluconazole (in one RCT), which studied a total of 1974 patients, were included in our review. Success of the applied treatment in the clinically evaluable patients was achieved in 496/943 (52.6%) of the caspofungin-treated patients and in 381/852 (44.7%) of the amphotericin B- and lipid amphotericin B-treated patients. Discontinuation due to drug toxicity was significantly less common in patients receiving caspofungin than amphotericin B (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.07-0.85, random effects model). Development of nephrotoxicity, hypokalaemia and fever also occurred significantly less often with caspofungin than amphotericin B (OR 0.23, 95% CI 0.14-0.36, fixed effects model; OR 0.3, 95% CI 0.12-0.76, random effects model; and OR 0.26, 95% CI 0.08-0.79, random effects model, respectively). No difference in mortality was noted. Caspofungin was associated with better clinical outcomes (higher cure and fewer adverse effects) than amphotericin B in the treatment of patients with fungal infections.
Matthew E Falagas; Fotinie Ntziora; Gregoria I Betsi; George Samonis
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Publication Detail:
Type:  Journal Article; Review     Date:  2007-01-04
Journal Detail:
Title:  International journal of antimicrobial agents     Volume:  29     ISSN:  0924-8579     ISO Abbreviation:  Int. J. Antimicrob. Agents     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-15     Completed Date:  2007-03-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9111860     Medline TA:  Int J Antimicrob Agents     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  136-43     Citation Subset:  IM    
Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Athens, Greece.
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MeSH Terms
Antifungal Agents / therapeutic use*
Mycoses / drug therapy*,  mortality
Peptides, Cyclic / adverse effects,  therapeutic use*
Randomized Controlled Trials as Topic
Reg. No./Substance:
0/Antifungal Agents; 0/Echinocandins; 0/Peptides, Cyclic; 0/caspofungin

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