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ID 116538
Author
Kimura, Shun-ichi Jichi Medical University
Kanda, Yoshinobu Jichi Medical University
Iino, Masaki Yamanashi Prefectural Central Hospital
Fukuda, Takahiro National Cancer Center Hospital
Sakaida, Emiko Chiba University
Oyake, Tatsuo Iwate Medical University
Yamaguchi, Hiroki Nippon Medical School
Fujiwara, Shin-ichiro Jichi Medical University
Jo, Yumi Shimane University
Okamoto, Akinao Fujita Health University
Fujita, Hiroyuki Saiseikai Yokohama Nanbu Hospital
Takamatsu, Yasushi Fukuoka University
Saburi, Yoshio Oita Prefectural Hospital
Matsumura, Itaru Kindai University
Yamanouchi, Jun Ehime University
Shiratori, Souichi Hokkaido University
Gotoh, Moritaka Tokyo Medical University
Tamura, Kazuo Fukuoka University
Keywords
Neutropenia
D-index
D-index-guided early antifungal therapy
Empirical antifungal therapy
Micafungin
Content Type
Journal Article
Description
Objectives: The D-index is defined as the area over the neutrophil curve during neutropenia. The CEDMIC trial confirmed the noninferiority of D-index-guided early antifungal therapy (DET) using micafungin to empirical antifungal therapy (EAT). In this study, we evaluated the efficacy and safety of micafungin in these settings.
Methods: From the CEDMIC trial, we extracted 67 and 113 patients who received micafungin in the DET and EAT groups, respectively. Treatment success was defined as the fulfilment of all components of a five-part composite end point. Fever resolution was evaluated at seven days after the completion of therapy.
Results: The proportion of high-risk treatments including induction chemotherapy for acute leukemia and allogeneic hematopoietic stem cell transplantation was significantly higher in the DET group than in the EAT group (82.1% vs. 52.2%). The efficacy of micafungin was 68.7% (95%CI: 56.2–79.4) and 79.6% (71.0–86.6) in the DET and EAT groups, respectively. When we focused on high-risk treatments, the efficacy was 69.1% (55.2–80.9%) and 78.0% (65.3–87.7%), respectively (P = 0.30). There was no significant difference in any of the 5 components between the two groups.
Conclusions: The efficacy of micafungin in patients undergoing high-risk treatment was not strongly impaired in DET compared to that in EAT.
Journal Title
International Journal of Infectious Diseases
ISSN
12019712
NCID
AA12791510
Publisher
International Society for Infectious Diseases|Elsevier
Volume
100
Start Page
292
End Page
297
Published Date
2020-09-03
Rights
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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DOI (Published Version)
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language
eng
TextVersion
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departments
Medical Sciences