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Factors related to survival and treatment success in invasive candidiasis or candidemia: a pooled analysis of two large, prospective, micafungin trials

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Abstract

Crude and attributable mortality rates in patients with candidemia and invasive candidiasis remain unacceptably high. It is important to reach a more complete understanding of the risk factors underlying poor outcomes in patients with invasive Candida infections. Micafungin therapy has been assessed in two phase 3 trials compared to either liposomal amphotericin B or caspofungin. The availability of this large dataset allows the analyses of non-drug factors associated with survival and treatment success. A multivariate regression analysis was performed on data from the two trials separately and as a pooled analysis (N = 1,070). Analysis outcomes were survival at 42 days post-initiation of therapy and treatment success. For the pooled analysis, treatment success was significantly more likely for candidemia than invasive candidiasis. Both survival and treatment success were significantly less likely for the non-removal of catheter versus removal, Asian-Indians versus Caucasians, APACHE II score >20 to ≤30 and >30 versus ≤20, age ≥70 years versus <50 years, baseline corticosteroids, and persistent neutropenia. Survival was also significantly less likely for treatment in other regions versus North America and for patients with renal failure at baseline. These findings help to define non-antifungal drug factors that may impact survival and treatment success in invasive candidiasis or candidemia.

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Acknowledgments

This study was sponsored by Astellas Pharma Inc., and medical writing and editorial support was provided by Paul Hassan Ph.D. of Envision Pharma Ltd.

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Authors and Affiliations

  1. Clinical Research, Division of Infectious Diseases, Thomas Jefferson University, Suite 210, 211 South 9th Street, Philadelphia, PA, 19107, USA

    D. L. Horn

  2. University of Texas Medical School at Houston, 6431 Fannin, MSB 2.112, Houston, TX, 77030, USA

    L. Ostrosky-Zeichner

  3. University of Miami Miller School of Medicine, 1400 N.W. 10th Avenue, D90-A, Dominion Tower, #813A, Miami, FL, 33136, USA

    M. I. Morris

  4. III. Medizinische Klinik und Poliklinik, Klinikum der Johannes Gutenberg-Universität, Langenbeckstrasse 1, 55101, Mainz, Germany

    A. J. Ullmann

  5. Astellas Pharma Global Development Inc., 3 Parkway North, Deerfield, IL, 60015, USA

    C. Wu, D. N. Buell & L. L. Kovanda

  6. Klinik I für Innere Medizin, Zentrum für Klinische Studien (ZKS Köln; BMBF 01KN0706), Universität zu Köln, Kerpener Str. 62, 50937, Köln, Germany

    O. A. Cornely

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  1. D. L. Horn
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  2. L. Ostrosky-Zeichner
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  5. C. Wu
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  6. D. N. Buell
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  7. L. L. Kovanda
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  8. O. A. Cornely
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Correspondence to D. L. Horn.

Additional information

Presented in part at the following congresses:

18th Annual European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Barcelona, Spain, April 19–22, 2008;

Joint Meeting: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Annual Meeting of the Infectious Diseases Society of America (ICAAC/IDSA), Washington, DC, USA, October 25–28, 2008;

38th Congress of the Society of Critical Care Medicine (SCCM), Nashville, TN, USA, January 31–February 4, 2009.

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Horn, D.L., Ostrosky-Zeichner, L., Morris, M.I. et al. Factors related to survival and treatment success in invasive candidiasis or candidemia: a pooled analysis of two large, prospective, micafungin trials. Eur J Clin Microbiol Infect Dis 29, 223–229 (2010). https://doi.org/10.1007/s10096-009-0843-0

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  • DOI: https://doi.org/10.1007/s10096-009-0843-0

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