O2-7-4 - Micafungin Compared with Voriconazole for Empirical Antifungal Therapy in Patients with Neutropenia and Persistent Fever

Abstract

Objectives: Patients with haematological malignancy who experience persistent fever and neutropenia often receive empirical antifungal therapy for the prevention and early treatment of invasive fungal infections. Micafungin (MCFG), a member of the echinocandin class of compounds, may be an effective alternative that is better tolerated than voriconazole (VRCZ).Methods: We conducted a randomised, cooperative group, open-label trial, comparing the efficacy and safety of micafungin with those of voriconazole as empirical antifungal therapy in febrile neutropenic patients with haematological malignancy. A successful outcome was defined as the fulfilment of all components of a 5-part composite endpoint.Results: Efficacy was evaluated in 100 patients (MCFG: 50, VRCZ: 50). Overall, favourable responses were observed in 52.0% of MCFG and 34.0% of VRCZ recipients (p = 0.069). There were no significant differences between the 2 groups in the rates of successful treatment of baseline fungal infection, absence of breakthrough fungal infection, survival for ≥7 days after treatment completion, or resolution of fever in the setting of neutropenia. Premature study discontinuation occurred less often in the MCFG group than in the VRCZ group (p = 0.001). Fewer patients who received MCFG experienced drug-related adverse events (p = 0.002).Conclusions: MCFG is as effective as and is generally better tolerated than VRCZ when given as empirical antifungal therapy in patients with persistent fever and neutropenia.