K-1393. Non-drug Factors Related to Survival and Treatment Success in Patients with Invasive Candidiasis or Candidemia: A Meta-Analysis of Two Large, Prospective, Micafungin Trials
Session: Poster Session: Candida Infections, Risk Factors and Treatment
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: Two Phase 3 clinical trials demonstrated non-inferiority of micafungin (MICA) versus liposomal amphotericin B (L-AmB) or caspofungin (CASPO) for the treatment of invasive candidiasis (IC) and candidemia. This large combined dataset presents an opportunity to analyze non-drug risk factors associated with survival and treatment success in patients with IC or candidemia. Methods: A multivariate regression meta-analysis was performed on data from 2 trials of patients with confirmed baseline Candida infection (N=1072). Analysis outcomes were survival at 42 days post-initiation of therapy and treatment success (clinical and mycological response). Results: Survival was significantly more likely for surgical patients, as was treatment success for candidemia patients (see table). Both survival and treatment success were significantly less likely for non-removal of catheter versus removal, Asian-Indians versus Caucasians, APACHE II score >20 to ≤30 and >30 versus ≤20, age ≥70 years versus <50, baseline corticosteroids, and persistent neutropenia. Survival was also significantly less likely for treatment in other regions versus North America and for patients with renal failure at baseline. Conclusion: These findings help to define non-drug factors that may impact survival and treatment success after therapy for IC or candidemia.
Table: Odds ratios (95% confidence intervals) for factors significantly associated with 42-day survival rate and treatment success
SurvivalTreatment Success
Catheter not removed versus removed0.572
(0.414, 0.792)
0.604
(0.439, 0.832)
Region: Other versus North America0.473
(0.322, 0.693)
NA
APACHE II score >20 to ≤30 versus ≤200.327
(0.227, 0.471)
0.479
(0.335, 0.684)
APACHE II score >30 versus ≤200.133
(0.061, 0.290)
0.178
(0.088, 0.359)
Age ≥70 versus <50 years0.445
(0.292, 0.678)
0.591
(0.390, 0.895)
Corticosteroid therapy at baseline0.644
(0.449, 0.923)
0.531
(0.376, 0.751)
Renal failure at baseline0.598
(0.396, 0.904)
NA
Persistent neutropenia during therapy0.307
(0.153, 0.614)
0.372
(0.189, 0.732)
Surgery at baseline1.644
(1.046, 2.585)
NA
Invasive candidiasis versus candidemiaNA0.601
(0.404, 0.894)
Race: Asian-Indian versus Caucasian0.462
(0.304, 0.701)
0.439
(0.290, 0.663)
NA: No significant association
Andrew Ullmann, MD1, Chunzhang Wu2, David Horn, MD3, Don Buell2, Laura Kovanda2, Luis Ostrosky-Zeichner, MD, FIDSA4, Michele Morris, MD5, Oliver Cornely, MD, FIDSA6 and  D. L. Horn,
Astellas Pharma Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee), Speaker's Bureau, Received: Grant Recipient, Speaker Honorarium, Consulting Fee.
Roche Role(s): Speaker's Bureau, Received: Speaker Honorarium., (1)Johannes Gutenberg-Universitšt, (2)Astellas Pharma US Inc, (3)Thomas Jefferson University Hospital, Horsham, United Kingdom, (4)TREAT Study Group, Houston, TX, (5)University of Miami Miller School of Medicine, Miami, FL, (6)Uniklinik koln, Cologne, Germany