| Background:Due to more extensive solid-organ transplantation and malignant tumor chemotherapy, as well as abuse of broad-spectrum antibiotics, prevalence of acquired immune deficiency syndrome (AIDS) and aging of population, the frequency of invasive fungal infections (IFI) have been increasing dramatically in recent years, which is accompanied by excessive morbidity and mortality. Given that the cost of treatment caused a heavy social burden, IFI has become one of the world’s most serious public health problems. Currently, some classes of antifungal drugs, such us polyenes, triazoles and echinocandins, are widely used for treatment of IFIs in the clinic. Caspofungin, the first approved echinocandin antifungal agent, is attracting more and more attention. However, doubts about the clinical therapeutic effect of caspofungin still exist. This study is aim at providing a general evaluation of efficacy and safety of caspofungin in the treatment of IFIs.Objective:To summarize the proper applications of caspofungin comparing with other kinds of antifungal agents in clinical and thus afford a better understanding of caspofungin for doctors.Methods:We first set the search terms as "caspofungin, cancidas, echinocandin, invasive fungal infection, invasive candida infection, invasive aspergillosis, antimycotic, antifungal, invasive fungal disease, invasive candida disease" in English and Chinese, which were combined using Boolean connectives "and" and "or". Then a systematical search of both English and Chinese literatures from following databases was carried out:Pubmed, Elsevier ScienceDirect, Database Research Center under Chongqing Branch of Institute of Scientific & Technical Information of China (CB-ISTIC), WANFANG DATA and China National Knowledge Infrastructure (CNKI). English and Chinese were set as search language, while literature types were not concerned. Target literatures were chosed according to the strict research criteria. We evaluated the desired literatures using Jadad scale, and literatures that got scores more than 3 were classified as "high-quality studies", and the rest were thought as "low-quality studies". Appropreciate randomized controlled trials (RCTs) of caspofungin were included in this retrospective study, executed using RevMan software version 5.0. Analysis of the statistics was performed to evaluate therapeutic effect and safety of caspofungin against IFIs. Q test and 12 calculation were used in heterogeneity analysis. With regard to dichotomous data type, M-H method was adopted to merge effect size, and effect size was expressed as odds ratio (OR) with 95% confidence interval (CI). For continuous data type, inverse variance method was used to merge effect size, and effect size was expressed as weighted mean difference (WMD) with 95% confidence interval (CI). The inspection level was a=0.05.Results:1.12 RCTs were contained, and a total of 1055 patients were enrolled. According to ITT principle,48 patients were eliminated, and the rest 1007 ones were divided into two groups in the study:501 patients in the test group (caspofungin) and 506 ones in the control group (amphotericin B, amphotericin B liposomes, itraconazole, voriconazole and micafungin).2. Analysis of efficacy of caspofungin and drugs in the control group:(1) The total effective rate exceeded that of amphotericin B (P=0.0003). (2) The total effective rate was higher than that of itraconazole, P=0.001. (3) For treatment of invasive monilial infection, the total effective rate of test group was superior than itraconazole, micafungin and amphotericin B (P=0.0001). (4) For treatment of invasive aspergillus infection, the total effective rate of caspofungin group was higher than voriconazole, itraconazole and micafungin, P=0.28.3. Incidence of adverse effect of test group was significantly lower than amphotericin B, amphotericin B liposomes, itraconazole and voriconazole, with statistical difference.Conclusions:1. Compared with amphotericin B, amphotericin B liposomes, itraconazole and voriconazole, caspofungin exhibited remarkably less adverse effect and better safety.2. For empirical or preemptive anti-IFI therapy, caspofungin achieved better therapeutic effect than amphotericin B, itraconazole.3. For treatment of diagnosed invasive monilial infection, caspofungin displayed higher efficacy than itraconazole, micafungin and amphotericin B.4. For treatment of diagnosed invasive aspergillus infection, caspofungin was no better than voriconazole, itraconazole and micafungin. |
