Caspofungin for prophylaxis and treatment of fungal infections in adolescents and adults: a meta-analysis of randomized controlled trials.

BACKGROUND AND OBJECTIVE: Caspofungin, a novel echinocandin compound, has been approved for the treatment of esophageal and suspected invasive candidiasis and as salvage therapy for invasive aspergillosis. The aim of this study was to assess the efficacy and safety of caspofungin for the prophylaxis and treatment of fungal infections, compared with other medications. METHODS: PubMed, Embase, and the Cochrane Library were searched to identify relevant randomized controlled trials (RCTs) of caspofungin. Nine RCTs were included in this meta-analysis, performed using Review Manager Version 5.0. Analyses of favorable response, microbiological response, mortality rate, survival rate, relapse rate, and adverse events were performed to evaluate caspofungin. RESULTS: Caspofungin produced similar effects in favorable response rate [relative risk (RR) = 1.07, 95% confidence interval (CI) 0.98-1.17], microbiological response rate (RR = 1.02, 95%CI 0.90-1.15), mortality rate (RR = 0.98, 95%CI 0.78-1.24), survival rate after 7-day follow-up (RR = 1.00, 95% CI 0.91-1.10), and relapse rate (RR =1.18, 95% CI 0.81-1.73) compared with other antifungal agents in the prophylaxis and treatment of patients with fungal infections, particularly those caused by Candida. There were significant differences in clinical and laboratory adverse events between caspofungin and other antifungal agents in favor of caspofungin (RR = 0.66, 95% CI 0.49-0.89) (RR = 0.66, 95% CI 0.57-0.75). CONCLUSION: This meta-analysis shows that caspofungin can be used as effectively as other antifungal agents for prophylaxis and treatment of fungal infections, mainly for Candida, and that it is associated with fewer adverse effects than comparable agents.