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Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven
Victoria C Grant1,2, Kenneth Nguyen2, Sasha Rodriguez2
1Department of Pharmacy Practice, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Abstract:
Micafungin is the empiric antifungal agent of choice for the treatment of invasive candidiasis (IC). Pathophysiologic changes that occur in obese and/or critically ill patients can alter micafungin serum concentrations and the probability of target attainment. Although high doses of micafungin have been shown to be safe, clinical outcomes have not been widely evaluated. We conducted a single-center, retrospective observational study evaluating safety and clinical outcomes among adult patients treated with ≥200 mg of micafungin for ≥3 days for proven IC from 1 September 2013 through 1 September 2021. Twenty-three unique encounters for 21 patients were evaluated. The median BMI and APACHE II scores were 37.1 (IQR 28.8-48.9) and 24 (IQR 17.7-31), respectively. The median average daily dose of micafungin was 300 mg (IQR 275-400). Patients were treated with high-dose (HD) micafungin for the entirety of their echinocandin course in 15 encounters (65.2%). Transaminases remained stable, while a trend towards increased alkaline phosphatase was observed. A total of four deaths occurred (17.4%). Patients that died were predominantly young, Hispanic males who were obese and/or critically ill. Future studies are needed to determine the necessity and appropriate placement of HD micafungin in obese and/or critically ill patients.
Insights
High-dose micafungin (≥200 mg) appears safe for invasive candidiasis (IC) in obese patients, though outcomes require further study. Dosing adjustments may be needed for critically ill patients.
Area of Science:
- Pharmacology
- Infectious Diseases
- Critical Care Medicine
Background:
- Micafungin is a primary antifungal for invasive candidiasis (IC).
- Obesity and critical illness can affect micafungin levels and treatment efficacy.
- High-dose micafungin safety is established, but clinical outcomes are less understood.
Purpose of the Study:
- To evaluate the safety and clinical outcomes of high-dose micafungin (≥200 mg) in obese and/or critically ill patients with proven IC.
Main Methods:
- Single-center, retrospective observational study.
- Inclusion criteria: adult patients with proven IC treated with ≥200 mg micafungin for ≥3 days.
- Data collected on patient demographics, BMI, APACHE II scores, micafungin dosage, safety, and clinical outcomes.
Main Results:
- 23 encounters (21 patients) evaluated; median BMI 37.1, median APACHE II 24.
- Median micafungin dose 300 mg; 65.2% received high-dose for entire course.
- Stable transaminases, trend towards increased alkaline phosphatase; 17.4% mortality.
Conclusions:
- High-dose micafungin demonstrated acceptable safety in this cohort.
- Deaths occurred predominantly in young, Hispanic males who were obese and/or critically ill.
- Further research is needed to define optimal high-dose micafungin use in specific patient populations.
