Comparative Efficacy of Echinocandins and Nonechinocandins for the Treatment of Candida parapsilosis Infections A Meta-analysis

Study Objective To compare the efficacy of echinocandins and nonechinocandins in the treatment of candidemia or invasive candidiasis due to Candida parapsilosis Design Meta-analysis of five randomized, blinded, comparative trials Patients A total of 1169 patients (mean age 55 5 yrs, 57 8% male) with invasive candidiasis or candidemia treated with an echinocandin or other antifungal agents Measurements and Main Results The PubMed, MEDLINE, Toxnet, and Cochrane Central Register of Controlled Trials databases were searched for relevant English-language articles to identify appropriate randomized trials The quality of studies was assessed with the Jadad scoring system Data on number of patients, age, and treatment success rate were extracted by two investigators independently into a standardized data collection form Overall C parapsilosis treatment success rates with echinocandins were compared with nonechinocandins Jadad scores of the five studies that met all of the selection criteria ranged from 2-5 (out of 5), with a median of 4 Among the 1169 patients with invasive candidiasis or candidemia, 202 (17 3%) had C parapsilosis Among these C parapsilosis cases, 102 received an echinocandin and 100 received a comparator drug The success rates of treating C parapsilosis were similar for the echinocandin group versus other antifungal treatment groups (76 5% [78/102] vs 73% [73/100]) A fixed-effects model was applied secondary to a low level of heterogeneity among the studies (I-2=0%) The combined risk ratio demonstrated that echinocandins are not significantly different from other antifungal agents for the treatment of candidemia or invasive candidiasis due to C parapsilosis (risk ratio 1 03, 95% confidence interval 0 88-1 21) Conclusion Echinocandins are as effective as comparator drugs for the treatment of candidemia or invasive candidiasis due to C parapsilosis