Summary
Objectives
To compare the effectiveness and tolerability of micafungin versus posaconazole during
chemotherapy-induced neutropenia in acute leukemia (AL) and myelodysplastic syndrome
(MDS).
Methods
Patients with AL or MDS undergoing chemotherapy were randomized to open-label micafungin
100 mg intravenously daily or posaconazole suspension 400 mg orally twice daily until
neutrophil recovery, up to 28 days. Patients were followed for 12 weeks. The primary
endpoint was prophylaxis failure (premature discontinuation due to infection, intolerance,
adverse event, or death). Time to failure and survival were calculated by Kaplan–Meier
analysis.
Results
From March 2011 to May 2016, 113 patients who received at least 2 doses of prophylaxis
were analyzed (58 patients randomized to micafungin and 55 to posaconazole). Prophylaxis
failure occurred in 34.5% and 52.7% of patients on micafungin and posaconazole, respectively
(P = 0.0118). The median number of days on prophylaxis was 16 [interquartile range (IQR)
12–20] for micafungin and 13 [IQR 6–16] for posaconazole (P = 0.01). Micafungin failures were largely due to antifungal treatment; posaconazole
failures were mostly due to gastrointestinal intolerance or adverse effects. IFI incidence
and survival were similar between study arms.
Conclusions
Our data support micafungin as alternative antifungal prophylaxis in patients with
AL and MDS.
Keywords
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Article info
Publication history
Published online: May 07, 2018
Accepted:
March 4,
2018
Received in revised form:
March 2,
2018
Received:
December 19,
2017
Identification
Copyright
© 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
