An echinocandin vs. a comparator antifungal in Candida bloodstream infections: a meta-analysis
Abstract number: O410
Golan Y., Harrison D., Fahrbach K.
Objective: Mortality from Candida bloodstream infections (CBSI) is high if not treated adequately. In recent clinical trials of CBSI, treatment with an echinocandin resulted in higher success rates. However, superiority has not been demonstrated. Given similarities in trial design and definitions, data from these trials can be combined in a metaanalysis. We compared the efficacy, measured as global clinical success at the end of intravenous therapy, of an echinocandin vs. a comparator AF agent in the treatment of CBSI.
Methods: We used standard metaanalysis methodology and a random effect model. We conducted a literature search to identify all randomized, controlled, trials (RCTs), assessing the efficacy of an echinocandin (caspofungin, micafungin, anidulafungin) in CSBI. To evaluate whether the comparator (fluconazole or amphotericin preparations) success rates were consistent with previously published data, we conducted an additional literature search of all RCTs in which these agents were evaluated. Articles were reviewed independently by 2 reviewers. The corresponding authors and sponsors were approached for additional data.
Results: 8 RCTs were included: 3 comparing an echinocandin to comparator antifungal (CAF), 1 comparing two echinocandins, and 4 comparing amphotericin preparations to fluconazole. The summary odds ratio for global success was 1.58 (95% CI 1.073.54) in favor of echinocandin therapy. The removal of a high-recruiting center that had a high anidulafungin response-rate had an insignificant impact on the results (OR 0. 1.46 95% CI 1.101.94). Global success rates observed in all included RCTs of fluconazole (5 treatment arms), amphotericin (4 arms) and the echinocandins (5 arms) were 62%, 73%, and 83%, respectively. In the echinocandin trials, success rates observed in the CAF arms were consistent with prior published trials. In an additional analysis that included only CBSI caused by C. albicans, echinocandin therapy resulted in higher success rate vs the CAF (74%; 95% CI 6978% vs 59%; 95% CI 5166%).
Conclusions: In patients with CBSI, as compared to amphotericin preparations or fluconazole, echinocandin therapy is associated with higher global success rates. This better effect is maintained when restricting the analysis to C. albicans, suggesting that effectiveness differences may be unrelated to the level of fluconazole susceptibility.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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