Caspofungin versus liposomal amphotericin B for treatment of invasive fungal infections or febrile neutropenia

Abstract

Background Nowadays, there are published trials in regards to the comparison of caspofungin with liposomal amphotericin B (L-AmB). However, these studies have a modest sample size and convey inconclusive results. The aim of this study was to review the efficacy and safety of caspofungin for the treatment of invasive fungal infections (IFIs), compared with L-AmB. Methods Electronic databases (up to July 31, 2013) PubMed and Embase databases, the Cochrane Library, and Google Scholar were searched to identify relevant trials of caspofungin and L-AmB. Analyses of efficacy and adverse outcomes were performed by relative risks (RRs) and 95% confidence intervals (CIs). Heterogeneity was assessed by χ 2-test and the I2 -statistic. Results Three trials were included in this meta-analysis with 1249 modified intention-to-treat (MITT) patients. The results showed that caspofungin produced equal efficacy in favorable overall response (RR=1.02, 95% CI 0.88-1.18; P=0.81) and mortality rate (RR=1.53, 95% CI 0.38-6.27, P=0.55), safer in clinical adverse events (RR=0.20, 95% CI 0.08-0.54; P=0.001), laboratory adverse events (RR=0.69, 95% CI 0. 57-0.84; P=0.0002), and discontinuation rate (RR=0.26, 95% CI 0.08-0.83, P=0.02), compared with L-AmB in the treatment of patients with IFIs. Conclusion Based on the results of this meta-analysis, it would appear that caspofungin was measured to have equal efficacy in clinical outcomes and safer in terms of adverse events.