From the Guidelines
Caspofungin and Amphotericin B are equally effective for the treatment of fungal pneumonia, but caspofungin is better tolerated.
Comparison of Caspofungin and Amphotericin B
- Both caspofungin and liposomal amphotericin B (L-AmB) are recommended for empiric and pre-emptive treatment in neonates and children with fungal pneumonia, with a strength of recommendation of A and quality of evidence of I 1.
- Caspofungin was found to be as effective as L-AmB in treating fungal pneumonia, with similar efficacy observed in pediatric haemato-oncologic patients 1.
- Caspofungin is better tolerated than L-AmB, with less toxicity and nephrotoxicity compared to other amphotericin B formulations 1.
- L-AmB is preferred over amphotericin B deoxycholate (AmB-D) due to its reduced toxicity and nephrotoxicity 1.
Treatment Recommendations
- Caspofungin or L-AmB should be used for empiric antifungal therapy in children with fungal pneumonia, with a strong recommendation and high-quality evidence 1.
- AmB-D may be considered as an alternative in settings with limited resources, but it is not the preferred choice due to its higher toxicity and nephrotoxicity 1.
- The treatment should be continued until resolution of neutropenia and fever, or until documented or suspected invasive fungal disease (IFD) is resolved 1.
From the FDA Drug Label
The efficacy of caspofungin in patients with intra-abdominal abscesses, peritonitis and pleural space Candida infections was evaluated in 19 non-neutropenic patients. ... Overall, across all sites of infection included in the study, the efficacy of caspofungin was comparable to that of amphotericin B for the primary endpoint. A favorable response was seen in ... 0 of 1 with Candida pneumonia
- Comparison between Caspofungin and Amphotericin B: The FDA drug label does not provide sufficient information to directly compare the efficacy of caspofungin and amphotericin B for the treatment of fungal pneumonia, as there was only one patient with Candida pneumonia in the study and the response was not favorable 2.
From the Research
Comparison of Caspofungin and Amphotericin B
- Caspofungin and Amphotericin B are two antifungal agents used to treat fungal infections, including fungal pneumonia.
- A systematic review of randomized controlled trials found that caspofungin was associated with better clinical outcomes and fewer adverse effects compared to amphotericin B in the treatment of patients with fungal infections 3.
- The review included six RCTs comparing caspofungin with amphotericin B, which studied a total of 1974 patients, and found that success of the applied treatment was achieved in 52.6% of caspofungin-treated patients and 44.7% of amphotericin B-treated patients.
Efficacy and Safety
- A meta-analysis of three trials found that caspofungin produced equal efficacy in favorable overall response and mortality rate, but was safer in terms of clinical adverse events, laboratory adverse events, and discontinuation rate compared to liposomal amphotericin B in the treatment of patients with invasive fungal infections 4.
- A randomized, double-blind, multinational trial found that caspofungin was as effective as and generally better tolerated than liposomal amphotericin B when given as empirical antifungal therapy in patients with persistent fever and neutropenia 5.
- Another study found that caspofungin combined with an azole or with amphotericin B may be of interest in the treatment of serious fungal infections after failure of conventional therapy, but close monitoring of hepatic function is required 6.
Treatment of Fungal Pneumonia
- Fungal pneumonias are most frequently caused by Aspergillus spp., dimorphic fungi, and Cryptococcus neoformans, and can be treated with antifungal agents such as caspofungin and amphotericin B 7.
- Caspofungin has been approved by the US Food and Drug Administration for the treatment of invasive Aspergillus infections in patients unresponsive to or unable to receive amphotericin B 7.
- Recent advances in diagnostic strategies and prophylactic strategies, such as the use of aerosolized formulations of amphotericin B, have been explored to improve identification and treatment of fungal pneumonia 7.