Title |
Retrospective cohort study comparing the risk of severe hepatotoxicity in hospitalized patients treated with echinocandins for invasive candidiasis in the presence of confounding by indication
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Published in |
BMC Infectious Diseases, August 2018
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DOI | 10.1186/s12879-018-3333-0 |
Pubmed ID | |
Authors |
Francis Vekeman, Lisa Weiss, Jalal Aram, Raluca Ionescu-Ittu, Shahrzad Moosavi, Yongling Xiao, Wendy Y. Cheng, Rachel H. Bhak, Margaret Tawadrous, M. Rita Capparella, Philippe Montravers, Mei Sheng Duh |
Abstract |
To compare the risk of severe hepatotoxicity with anidulafungin versus caspofungin and micafungin in hospitalized adults. This retrospective cohort study combined data from two large US- based hospital electronic medical record databases. Severe hepatotoxicity was a Grade ≥ 3 liver function test (LFT) post-echinocandin initiation. Adjusted incidence rate ratios (IRRs) were estimated for anidulafungin versus caspofungin and micafungin, overall and in patients with normal baseline LFT (Grade 0). Treatments included anidulafungin (n = 1700), caspofungin (n = 4431), or micafungin (n = 6547). The proportions with LFT Grade ≥ 3 pre-echinocandin initiation were: anidulafungin 40.4% versus caspofungin 25.9% (p < 0.001) and micafungin 25.6% (p < 0.001). Rates of severe underlying diseases or comorbidities were: critical care admissions: 75.3% versus 52.6 and 48.6%; and organ failures: 69.4% versus 46.7 and 51.5%. Adjusted IRRs of severe hepatotoxicity for anidulafungin versus caspofungin and micafungin were 1.43 (p = 0.002) and 1.19 (p = 0.183) overall, and 0.88 (P = 0.773) and 0.97 (P = 0.945) for normal baseline LFT, respectively. Accounting for confounders, severe hepatotoxicity risk was not significantly different across echinocandins in this real-world head-to-head study. Anidulafungin was used more frequently in patients with more comorbidities. Those with normal baseline LFT (least susceptible to confounding by indication), showed no elevated hepatotoxicity risk for anidulafungin. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 4 | 33% |
Russia | 1 | 8% |
Malaysia | 1 | 8% |
Unknown | 6 | 50% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Scientists | 5 | 42% |
Members of the public | 5 | 42% |
Practitioners (doctors, other healthcare professionals) | 2 | 17% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 38 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 6 | 16% |
Student > Bachelor | 3 | 8% |
Researcher | 3 | 8% |
Student > Ph. D. Student | 3 | 8% |
Student > Postgraduate | 2 | 5% |
Other | 6 | 16% |
Unknown | 15 | 39% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 7 | 18% |
Pharmacology, Toxicology and Pharmaceutical Science | 5 | 13% |
Nursing and Health Professions | 4 | 11% |
Agricultural and Biological Sciences | 1 | 3% |
Immunology and Microbiology | 1 | 3% |
Other | 5 | 13% |
Unknown | 15 | 39% |