666. Utilization Patterns of Caspofungin and Micafungin for Treating Invasive Fungal Infections
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Micafungin 100mg and 150mg daily has demonstrated non-inferior efficacy versus caspofungin 70mg on day one (loading dose) followed by 50mg daily (maintenance dose) in invasive candidiasis (IC). For invasive aspergillosis (IA) and IC, caspofungin has standard approved dosing (70mg on day 1 followed by 50mg daily). Micafungin has an approved recommended dosing of 100mg per day (IC) and is not approved to treat IA.  This study evaluated utilization patterns of caspofungin and micafungin in US hospitals in patients diagnosed with IC and IA.

Methods: The Aspen Healthcare Metrics Navigator database was analyzed. Patients discharged between 01/07 and 12/09 with ICD-9 diagnosis codes of 112.5 (IC) and 117.3 (IA), receiving caspofungin or micafungin were included.  Standard dosing for caspofungin was defined as a maintenance dose of 50mg daily during hospital stay (IC and IA) and for micafungin as 100mg daily (IC) and 100mg or 150mg daily (IA) during hospital stay.  Non-standard dosing included escalation or de-escalation of dose during the hospitalization or doses inconsistent with the standard dosing definition.

Results: Over the 3-year period, 214 patients received caspofungin for IC (53 alone and 161 combination therapy) and 66 patients for IA (6 alone and 60 combination therapy).  Similarly, 164 patients received micafungin for IC (42 alone and 122 as part of combination therapy) and 50 patients for IA (5 alone and 45 as part of combination therapy).  For IC, standard dosing for caspofungin and micafungin was observed in 182 (85%) and 109 (66%) patients, respectively.  For IA, standard dosing for caspofungin and micafungin was observed in 59 (89%) and 38 (76%) patients, respectively.  Among the standard dosing observed for micafungin in IA, 32% of patients received 150mg daily.  Evaluating patients who only used micafungin or caspofungin during their hospital stay, more average days therapy for micafungin versus caspofungin were observed for treatment of IA (10.8 vs. 5.5) and IC (8.8 vs. 6.8), respectively.

Conclusion: Based on study definitions, caspofungin demonstrated higher rates of standard dose utilization versus micafungin.

Subject Category: M. Mycology including clinical and basic studies of fungal infections

Connie Parks , Aspen Healthcare Metrics, Centennial, CO
Ritesh Kumar, Ph.D. , Global Health Outcomes, Merck & Co., Inc., Whitehouse Station, NJ
Girish D. Prajapati, M.B.B.S., MPH , Pharmacy Practice and Administration, Global Health Outcomes, Rutgers The State University, Merck & Co., Inc., Whitehouse Station, NJ
Blane Schilling, MD , Aspen Healthcare Metrics, Centennial, CO


C. Parks, None

R. Kumar, None

G. D. Prajapati, None

B. Schilling, None

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