EFFICACY AND SAFETY OF CASPOFUNGIN VERSUS LIPOSOMAL
AMPHOTERICIN B IN THE TREATMENT OF INVASIVE FUNGAL
INFECTIONS: SYSTEMATIC REVIEW AND META-ANALYSIS
PENTEADO, SUELEM TAVARES DA SILVA (1); WIENS, ASTRID (1);
LEONART, LETÍCIA (1), PONTAROLO, ROBERTO (1)
[email protected]
(1)
FEDERAL UNIVERSITY OF PARANÁ - UFPR
Address: Avenue Pref. Lothario Meissner, 632 - Botanical Garden
CEP: 80210-170 - Curitiba - Paraná - Brasil
AREA: pharmaceutical care and evaluation of health technologies
KEYWORDS: caspofungin, meta-analysis, invasive fungal infection, eficacy, safety
Background and aim: Invasive fungal infections are the main causes of morbidity and
mortality, especially in the immunocompromised patients. In the last 30 years, there
has been an increase of these infections in humans, accompanied by an increase in
the number of antifungals. The caspofungin, of the echinocandin´s class was recently
approved and has been incorporated in clinical practice for the treatment of invasive
aspergillosis and candidiasis. The aim of this study was to evaluate the efficacy and
safety of caspofungin for the treatment of invasive fungal infections, compared to the
conventional treatment of liposomal amphotericin B. Methods: A systematic review
was performed and searches in the databases: Pubmed, Embase, IPA, Cochrane
Library, Scielo, Lilacs, Scopus and Web of Science, in order to identify randomized
clinical trials (RCTs) and double-blind studies of caspofungin which would be elegible
to compose the meta-analysis. Then, procedded to analysis of title and abstract,
followed by analisys of the full text and data extraction. Using the software Review
Manager 5.0, meta-analysis were elabored of the outcomes: favorable overall
response, rate of mortality, adverse events and tolerability (measured by
discontinuation of patients to treatment) to evaluate the caspofungin versus
amphotericin B. The Mantel-Haenszel method was used and statistic model of random
effects. Sensitivity´s analysis were conducted and the heterogeneity were evaluated by
I2. Results: Three RCTs and double-blind studies were included in the meta-analysis.
The caspofungin and liposomal amphotericin B produced similar effects in the
mortality´s rate [relative risk (RR) = 0,55; confidence interval (CI) 95% 0,21-1,44] in the
treatment of patients with invasive fungal infections, particularly for candidiasis. There
were significant differences in favorable overall response (RR = 1,29; CI 1,01-1,67), in
clinics adverse events (RR = 0,36; CI 0,26-0,57) and laboratory adverse events (RR =
0,36; IC de 95% 0,25-0,50), as well on discontinuation due to these events (RR= 0,11;
CI 95% 0,04-0,33) between caspofungin and liposomal amphotericin B, all favoring the
caspofungin. Conclusion: This meta-analysis provide evidence that caspofungin is an
alternative significantly effective to the treatment of fungal infections, especially to
candidiasis and that is associated with less adverse events, being more tolerable.
Acknowledgments: To CAPES and CNPQ which provid financial support.