October 1, 2025

Effectiveness and Safety of Micafungin versus Fluconazole for Preventing Invasive Fungal Infections in Hematological Malignancy Patients: A Retrospective Cohort Study

Key Points

Micafungin and fluconazole showed comparable effectiveness and safety in preventing invasive fungal infections in hematological patients.
Treatment success rates were 63% for micafungin and 37% for fluconazole, with no significant differences in IFI onset or mortality.
Renal and liver function remained stable across both drug treatments, with slight increases in bilirubin levels noted in the micafungin group.
The findings suggest selecting antifungal agents based on individual patient circumstances, including renal function and mold pathogen risk.

Abstract

Abstract Background: Intensive chemotherapy used to treat acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) is most likely to cause invasive fungal infection (IFI). The use of echinocandins and broad-spectrum azoles for prophylaxis is growing; however, the outcomes are not always consistent. The objective of this study was to evaluate the effectiveness and safety of micafungin and fluconazole for the prevention of IFIs in patients with ALL and AML, who underwent intensive chemotherapy. Materials and Methods: A retrospective cohort study was conducted on adult patients with AML and ALL who were hospitalized between January 2010 and June 2023 at King Fahad Specialist Hospital-Dammam, who received intensive chemotherapy. The data were collected from the hospital information system (HIS). Results: Out of 95 patients, 57 (60%) patients were treated with micafungin group and 38 (40%) patients were with fluconazole. The two groups were comparable in terms of outcome, mortality and hepatotoxicities. The percentages of patients who experienced IFIs did not differ significantly between the micafungin and fluconazole groups ( P = 0.309). During prophylactic treatment, micafungin-treated group had numerically higher rate treatment success 63.24% n = 43/68 than fluconazole-treated group 36.76% n = 25/68. In spite of this, the two treatment groups did not differ significantly in terms of treatment success and probable IFIs ( P = 0.309). The onset of fungal infection was 21.5 days and 23.69 days in the fluconazole and micafungin group, respectively. The duration of onset of fungal infection did not differ between the two treatment groups ( P = 0.669). The median prophylactic treatment duration was 28 days in micafungin treatment group and 32 days in fluconazole group. In terms of therapy duration, there was no difference between the two treatment groups ( P = 0.826). There was no significant difference in mortality rate between the two arms, ( P = 0.608). There was no significant difference in renal and liver function between two treatment arms in terms of alanine transferase (ALT) ( P = 0.201), alkaline phosphate (AST) ( P = 0.14), and serum creatinine ( P = 0.153) elevation but the increase in total bilirubin level was observed in the micafungin group ( P = 0.034). No drug-related mortality or severe adverse drug reactions were reported. Conclusion: Micafungin and fluconazole are both considered to be safe and effective in the prophylaxis of fungal infections in patients with hematological malignancies. Micafungin has a favorable safety profile, while fluconazole has shown efficacy in reducing the incidence of fungal infections and mortality. The choice of these agents should be individualized according to the patient, renal function and the risk of specific mold pathogens.

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