Short-term risk of liver and renal injury in hospitalized patients using micafungin: a multicentre cohort study.

The Journal of antimicrobial chemotherapy

PubMedID: 27407049

Schneeweiss S, Carver PL, Datta K, Galar A, Johnson MD, Johnson MG, Marty FM, Nagel J, Najdzinowicz M, Saul M, Shoham S, Silveira FP, Varughese CA, Wilck M, Weatherby L, Auton T, Walker AM. Short-term risk of liver and renal injury in hospitalized patients using micafungin: a multicentre cohort study. J Antimicrob Chemother. 2016;.
BACKGROUND
Although echinocandins are generally well tolerated, there is little information on the frequency with which renal and hepatic adverse effects occur during use of micafungin or other parenteral antifungal (PAF) agents in clinical practice.

METHODS
MYCOS is a multicentre cohort study of adult and paediatric patients who received micafungin or other PAFs between 2005 and 2012 at seven tertiary care hospitals from six centres in the USA. PAF cohort controls were selected through propensity score (PS) matching to micafungin recipients using clinical characteristics, other treatments, procedures and hospital service where PAF treatment was initiated. Analysis was restricted to patients without chronic liver and kidney conditions at the time of cohort entry. Treatment-emergent hepatic and renal injury was documented by changes in liver enzymes or estimated glomerular filtration rate through 30 days following completion of PAF treatment. Comparisons were quantified using the HR from a proportional hazards analysis.

RESULTS
There were 2970 micafungin recipients PS matched to 6726 recipients of comparator PAFs. Balance was achieved in all baseline covariates between treatment groups. There were similar rates of hepatic injury (micafungin, 13 events per 100 patientsĀ and other PAF, 12 per 100; HR?=?0.99; 95% CI 0.86-1.14) and lower rates of renal injury (micafungin, 63 events per 100 patientsĀ and other PAF, 65 per 100; HR?=?0.93; 95% CI 0.87-0.99) for micafungin recipients versus PAF comparators.

CONCLUSION
For a wide spectrum of underlying conditions, we observed no increase in liver injury by micafungin and possibly a reduced risk of renal dysfunction in comparison with other PAF medications.