|
Anidulafungin |
MEC approval
- Anidulafungin is
recommended for formulary addition and caspofungin (Cancidas) will be removed
from formulary.
- Anidulafungin is not a
substrate, inhibitor or inducer of cytochrome P450 enzymes. It has only one
known drug interaction (cyclosporine), but anidulafugin’s does not require a
dosage adjustment
- Medications studied
include rifampin, cyclosporine, tacrolimus, voriconazole, and amphotericin
B
- Anidulafungin has the
longest half-life (26 hours) and the lowest protein binding (84%) of the
echinocandins.
- Anidulafungin is
chemically degraded in the body and is not metabolized by the cytochrome
P450 system
- Anidulafungin does not
require dosage adjustment for liver or renal dysfunction
- Anidulafungin is less
expensive than other echinocandins
- Anidulafungin provides
higher free levels than caspofungin and micafungin
- Anidulafungin’s
adverse effect profile appears to be better than other echinocandins
- Antifungal spectrums
of echinocandins are equivalent.
- Anidulafungin has a
broad spectrum activity against Candida (including those strains that are
resistant to polyenes and azoles), non-albicans strains and Aspergillus
species. Potential synergy with azoles against Aspergillus has been
demonstrated in vitro. It is inactive against Cryptococcus neoformans,
Trichosporon spp., Zygomycetes and Fusarium. All echinocandins are less
active against C. parapsilosis
- Anidulafugin is the
only echinocandin that has been studied in a randomized control trial versus
fluconazole in candidemia and other invasive candida infections (phase three
clinical trial, not published)
|
Efficacy Analysis: Global Success
(MITT)*
in Patients with Candidemia and other Candida Infections**, Package Insert |
|
Time Point |
Eraxis
200 mg LD, 100 mg/day
N=127 |
Fluconazole
800 mg LD, 400 mg/day
N=118 |
Treatment Difference %, (95% C.I) |
|
End of IV Therapy |
75.6% |
60.2% |
15.4% (3.9, 27) (SS) |
|
End of IV Therapy (candidemia) |
75.9% (88/116) |
61.2%
(63/103) |
14.7(2.5,26.9) (SS) |
|
End of All Therapy |
74% |
56.8% |
17.24% (2.9, 31.6) (SS) |
|
2 Week Follow-up |
64.6% |
49.2% |
15.4% (0.4, 30.4) (SS) |
|
6 Week Follow-up |
55.9% |
44.1% |
11.84% NS |
|
Overall Study Mortality |
22.8% |
31.4% |
NS |
|
Mortality During Study Therapy |
7.9% |
14.4% |
NS |
|
Mortality Attributed to Candida |
1.6% |
4.2% |
NS |
* Patients with at least 1 dose of study drug and a positive culture for Candida
species for a normally sterile site, clinical cure or improvement and documented
or presumed microbiological eradication
** Patients with C. krusei (fluconazole not active), candida endocarditis,
osteomyelistis, and meningitis were excluded from the study
|
