Caspofungin versus micafungin in the incidence of hepatotoxicity in patients with normal to moderate liver failure

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 23; no. 6; pp. 349 - 353
• Main Authors: Shibata, Yuichi, Hagihara, Mao, Kato, Hideo, Kawasumi, Noriyo, Hirai, Jun, Nishiyama, Naoya, Asai, Nobuhiro, Koizumi, Yusuke, Yamagishi, Yuka, Matsuura, Katsuhiko, Mikamo, Hiroshige
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2017
• Subjects: Adult; Aged; Aged, 80 and over; Antifungal Agents - adverse effects; Antifungal Agents - therapeutic use; Caspofungin; Echinocandins - adverse effects; Echinocandins - therapeutic use; Female; Hematology, Oncology and Palliative Medicine; Hepatotoxicity; Humans; Incidence; Lipopeptides - adverse effects; Lipopeptides - therapeutic use; Liver Failure - chemically induced; Liver Failure - complications; Liver Failure - epidemiology; Male; Micafungin; Middle Aged; Mycoses - complications; Mycoses - drug therapy; Mycoses - epidemiology; Retrospective Studies; Young Adult; Micafungin; Hepatotoxicity; Caspofungin
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1016/j.jiac.2017.02.008

Abstract Background One of the major adverse events of caspofungin and micafungin is hepatotoxicity, however, there are few reports compared the incidence of hepatotoxicity between caspofungin and micafungin. Herein, the primary objective of this study was to compare the incidence of hepatotoxicity between caspofungin and micafungin treatments for patients with fungal or suspected fungal infection. Methods In total, 201 patients [caspofungin group: 66 patients; micafungin group: 135 patients] treated with echinocandins from April 2014 to November 2015 at Aichi Medical University Hospital. Investigation item were as follows; sex, age, weight, height, duration of treatment, total dose, disease type, clinical isolates, liver enzyme levels, concomitant medications. Liver function was assessed in accordance with Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. We divided into two groups depend on their liver enzyme levels before treated with echinocandins; normal group (liver enzyme levels ≤ CTCAE Grade 1), abnormal group (liver enzyme levels ≥ CTCAE Grade 2). Results The overall incidence of serious hepatotoxicity (Grade 3 or higher) was 6.1% (4/66) in the caspofungin group and 7.4% (10/135) in the micafungin group. The proportion of patients used caspofungin and micafungin showed serious hepatotoxicity were 0% (0/47) and 6.5% (7/108) in normal group ( p  = 0.17), and 21.1% (4/19) and 10.7% (3/28) in abnormal group ( p  = 0.42). Conclusion There was no notable difference in serious hepatotoxicity between the caspofungin group and the micafungin group, even though in patients with abnormal liver enzyme levels (CTCAE grade 2 or higher).