Efficacy and safety of micafungin versus fluconazole for prophylaxis and treatment of fungal infections: a meta-analysis of randomized controlled trials

OBJECTIVE: To assess the efficacy and safety of micafungin versus fluconazole for prophylaxis and treatment of fun¬gal infections.

METHODS: We searched PubMed, EMbase, Cochrane library, CBM, CNKI, VIP and Wanfang database, and col¬lected the randomized controlled trials and prospective cohort studies of micafungin versus fluconazole for prophylaxis and treatment of fungal infections. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.1 software was used to carry out statistical analysis.

RESULTS: Five studies involving 1759 patients were included. The results of Meta-analysis showed the following facts; CD For antifungal prophylaxis: the treatment success rate of micafungin was significantly higher than fluconazole [OR=1.56, 95% CI (1.16, 2.10), P=0.004]. The breakthrough infections and frequency of possible fungal infections of micafungin were significantly lower than fluconazole [OR=0.42, 95% CI (0.19, 0.94), P=0.03], [OR=0.61, 95% CI (0.44, 0.85), P=0.003]. (2) For treatment of Candida infections; there was no significant difference between the two groups of endo¬scopic cure rates, clinical response at the end of treatment, overall therapeutic response, and incidence of relapse (P>0.05). (3) The overall incidence of drug-related adverse events of 150 mg micafungin was significantly higher than that of fluconazole [OR=1.46, 95% CI (1.00, 2.13), P=0.05]. (4) There was no significant difference between the two groups about the incidence of adverse reaction, such as rash, nausea, leucopenia, thrombocytopenia, fever, and injection site reaction (P>0.05).

CONCLUSION: Micafungin offers an appropriate alternative to fluconazole for antifungal prophylaxis rather than the treatment of invasive Candida infection. U-sing micafungin with a dose of 150 mg is not safer than fluconazole.