Randomized, Double-Blind, Multicenter Study of Caspofungin versus Amphotericin B for Treatment of Oropharyngeal and Esophageal Candidiasis [Arathoon EG et al. AAC 2002;46:451] The authors present a phase two, dose-ranging study in which AIDS patients with thrush or Candida esophagitis were randomized to receive one of three daily doses of caspofungin (35, 50 or 70 mg) or amphotericin B (0.5 mg/kg) IV once daily for 7-14 days. The results showed a trend toward superior clinical response and clearance of C. albicans in the caspofungin group, although the differences were not statistically significant. As expected, adverse reactions, especially infusion related adverse reactions, were far greater in the recipients of amphotericin B.

Esophageal and Oropharyngeal Candidiasis: Caspofungin vs. Amphotericin B
	Caspofungin n = 103*	Ampho B n = 35
Clinical response	86 (83%)	22 (62%)
C. albicans cleared	75%	55%
Infusion related ADR	<1%	69%
*Data for recipients of 35 mg, 50 mg or 70 mg are pooled

Comment: There are sparse data regarding caspofungin for candidiasis, but the results here show that it appears to be as good as amphotericin and certainly less toxic. For the condition treated, most physicians would use an azole by mouth for outpatients. It is unfortunate that this was not included as an additional arm of the study or that the entry criteria were not restricted to those who failed this more conventional and far less difficult IV treatment. Nevertheless, it is good to have these data regarding caspofungin for infections involving Candida species.
posted 2/08/2002

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