Future role of micafungin in the treatment of invasive mycoses caused by filamentous fungi

• Published in: Revista iberoamericana de micología 2009-03, Vol.26 (1), p.81-89
• Main Authors: Salavert-Lletí, Miguel, Zaragoza-Crespo, Rafael
• Format: Article
• Language: Spanish
• Subjects: Adult; Animals; Antifungal Agents - adverse effects; Antifungal Agents - pharmacokinetics; Antifungal Agents - therapeutic use; Aspergillosis - drug therapy; Aspergillus; Candida; Candidiasis - drug therapy; Child; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation, Preclinical; Echinocandins - adverse effects; Echinocandins - pharmacokinetics; Echinocandins - therapeutic use; Fluconazole - therapeutic use; Forecasting; Fungemia - drug therapy; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Lipopeptides - adverse effects; Lipopeptides - pharmacokinetics; Lipopeptides - therapeutic use; Multicenter Studies as Topic; Mycoses - drug therapy; Mycoses - prevention & control; Organ Transplantation; Postoperative Complications - prevention & control; Premedication; Prospective Studies; Randomized Controlled Trials as Topic; Zygomycosis - drug therapy
• ISSN: 1130-1406
• DOI: 10.1016/S1130-1406(09)70015-4

Micafungin is a echinocandin. It inhibits beta-1,3-D-glucan synthesis, thus achieving fungicidal activity against virtually all Candida spp., including those resistant to fluconazole, and fungistatic activity against Aspergillus spp., as well as several but not all pathogenic molds. Results from in vitro studies, animal models, small clinical trials, hint at possible future indications such as invasive aspergillosis and empirical viantifungal therapy, although currently there is little information published. To describe published data of micafungin as treatment against invasive mold infections, specially analysing its role in the inmunodepressed host and critical care setting. A systematic review of literature using the principal medical search engines was performed. Terms such as micafungin, aspergillosis, zygomycosis, invasive fungal infections, emerging fungal infections, antifungal treatment or therapy, antifungal prophylaxis, empiric or pre-emptive therapy were crossed. Febrile neutropenia patients were excluded. Several studies in these setting were identified and were described in this review. Although there were no blinded randomized clinical trials published, treatment or prophylaxis of invasive aspergillosis and other invasive mould infections with micafungin described in open clinical studies were analyzed. Micafungin could play a future important role as a primary or rescue therapy, alone or in combination, in the treatment or prophylaxis of invasive fungal infections caused by moulds. New randomized clinical trials are needed to confirm their efficacy.