A randomized double-blind study of caspofungin versus amphotericin for thetreatment of candidal esophagitis

Caspofungin is a new broad-spectrum antifungal drug. A multicenter, double- blind, randomized trial was conducted to assess the efficacy, safety, and t olerability of caspofungin relative to amphotericin B in adults with endosc opically documented symptomatic Candida esophagitis. By use of a modified i ntent-to-treat analysis, endoscopically verified clinical success was achie ved in 74% (95% confidence interval [CI], 59%-86%) and 89% (95% CI, 72%-98% ) of patients receiving caspofungin at 50 and 70 mg/day, respectively, and in 63% (95% CI, 49%-76%) of patients given amphotericin B at 0.5 mg/kg/day. Therapy was stopped because of drug-related adverse events in 24% of patie nts in the amphotericin B group and 4% and 7%, respectively, for the caspof ungin groups. This report provides the first demonstration of clinical util ity for an echinocandin compound. Caspofungin appeared in this study to be as effective as and better tolerated than amphotericin B for the treatment of esophageal candidiasis.