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Revista Espanola de Quimioterapia :... Jun 2008Anidulafungin is a new echinocandin antifungal agent recently approved in Spain by the Spanish Drug Agency. As other echinocandins, it inhibits a selective target, 1,3-... (Review)
Review
Anidulafungin is a new echinocandin antifungal agent recently approved in Spain by the Spanish Drug Agency. As other echinocandins, it inhibits a selective target, 1,3- beta-D-glucan synthesis, a major structural component of the fungal cell wall which is not present in mammalian cells, this avoiding toxicity problems. It has fungicidal activity against many Candida spp., including fluconazole-resistant, and fungistatic activity against other yeast and moulds such as Aspergillus spp. Clinical trials have shown non-inferiority of anidulafungin to fluconazole for invasive, including candidemia, and non-invasive Candida infections. It is well-tolerated, and no drug-related serious adverse events have been reported. Anidulafungin, which has a very long half life, is slowly degraded by human peptidases and proteases and has a low drug-drug interaction profile based on its lack of interaction with the cytochrome P450 system. Thus, dosing adjustments of anidulafungin based on age, gender, body weight, disease status, concomitant therapy or renal or hepatic insufficiency is not necessary. As it does not interact with amphotericin B and voriconazole, cyclosporine, tacrolimus and other drugs, it can be used in combination with other antifungal agents and co-administered with immunosuppressant drugs. It is generally well-tolerated in clinical trials. Its most frequent adverse events are nausea, vomiting, moderate diarrhea, transient elevation of hepatic enzymes and headache. Some of the patients have mild, passing reactions such as facial blushing, nausea and dyspnea related with rapid intravenous perfusion. Its antifungal activity, clinical efficacy, safety profile, and pharmacokinetic characteristics make it a suitable alternative antifungal compound for therapy of mucosal candidiasis, candidemia and invasive candidiasis, above all in patients with some degree of renal and hepatic insufficiency.
Topics: Anidulafungin; Animals; Antifungal Agents; Disease Models, Animal; Echinocandins; Humans; Mycoses
PubMed: 18509769
DOI: No ID Found -
Clinical Infectious Diseases : An... Jul 2006Until recently, the treatment available for serious fungal infections was composed of amphotericin B and azoles, and each class demonstrated significant limitations.... (Review)
Review
Until recently, the treatment available for serious fungal infections was composed of amphotericin B and azoles, and each class demonstrated significant limitations. Echinocandins are a new class of drugs that have shown promising results in treating a variety of fungal infections. Of these, anidulafungin is a novel echinocandin that appears to have several advantages over existing antifungals. It is unique because it slowly degrades in humans, undergoing a process of biotransformation rather than being metabolized. It has potent in vitro activity against Aspergillus and Candida species, including those resistant to fluconazole or amphotericin B. Results of several clinical trials indicate that anidulafungin is effective in treating esophageal candidiasis, including azole-refractory disease. The results of a recent study comparing fluconazole versus anidulafungin demonstrated the superiority of anidulafungin in the treatment of candidemia and invasive candidiasis (IC). Studies evaluating the concomitant use of anidulafungin and either amphotericin B, voriconazole, or cyclosporine did not demonstrate significant drug-drug interactions or adverse events. To date, anidulafungin appears to have an excellent safety profile. On the basis of early clinical experience, it appears that anidulafungin will be a valuable asset in the management of serious and difficult-to-treat fungal infections.
Topics: Anidulafungin; Antifungal Agents; Echinocandins; Fungal Proteins; Humans; Mycoses; Peptides, Cyclic
PubMed: 16779750
DOI: 10.1086/505204 -
Drugs 2004Anidulafungin is a novel antifungal agent which, like other echinocandins, inhibits beta-(1,3)-D-glucan synthase and disrupts fungal cell-wall synthesis. It has marked... (Comparative Study)
Comparative Study
Anidulafungin is a novel antifungal agent which, like other echinocandins, inhibits beta-(1,3)-D-glucan synthase and disrupts fungal cell-wall synthesis. It has marked antifungal activity against a broad spectrum of Candida spp. and Aspergillus spp., including amphotericin B- and triazole-resistant strains. In clinical trials, anidulafungin has primarily been evaluated in patients with oesophageal and invasive candidiasis. Preliminary data are emerging for other indications such as invasive aspergillosis. In a large, multicentre, double-blind, double-dummy, randomised trial in patients with oesophageal candidiasis, intravenous anidulafungin 50 mg/day was as effective as oral fluconazole 100 mg/day regarding end-of-treatment rates of endoscopic cure and clinical and microbiological success. Duration of treatment was approximately 2-3 weeks, and patients in both groups received a loading dose of study drug (twice the daily maintenance dose) on day 1. Anidulafungin is generally well tolerated. Across the dosage range 50-100 mg/day, adverse events appear not to be dose- or infusion-related. In the largest clinical trial to date, the most common treatment-related adverse events were phlebitis/thrombophlebitis, headache, nausea, vomiting and pyrexia.
Topics: Anidulafungin; Animals; Antifungal Agents; Aspergillosis; Aspergillus; Candida; Candidiasis; Cell Wall; Clinical Trials as Topic; Drug Administration Schedule; Drug Evaluation, Preclinical; Echinocandins; Esophageal Diseases; Glucosyltransferases; Humans; Infusions, Intravenous; Injections, Intravenous; Molecular Structure; New Zealand; Peptides, Cyclic; Time Factors; Treatment Outcome
PubMed: 15456342
DOI: 10.2165/00003495-200464190-00011 -
Drugs 2009Anidulafungin is a new echinocandin with potent in vitro activity against Aspergillus and Candida species, including those resistant to fluconazole and amphotericin B.... (Review)
Review
Anidulafungin is a new echinocandin with potent in vitro activity against Aspergillus and Candida species, including those resistant to fluconazole and amphotericin B. Results of several clinical trials indicate that anidulafungin is effective in treating oesophageal candidiasis, including azole-refractory disease. The results of a single randomized clinical trial comparing fluconazole and anidulafungin demonstrated that anidulafungin was noninferior to fluconazole in the treatment of candidaemia and invasive candidiasis. Studies evaluating the concomitant use of anidulafungin and either amphotericin B, voriconazole or ciclosporin did not demonstrate significant drug-drug interactions or adverse events. Anidulafungin appears to have an excellent safety profile: alterations of liver enzymes have been reported and slow infusion is recommended to prevent histamine-like reactions. On the basis of early clinical experience, it appears that anidulafungin will be a valuable option in the management of serious and difficult-to-treat fungal infections.
Topics: Anidulafungin; Animals; Antifungal Agents; Candidiasis; Echinocandins; Humans; Mycoses
PubMed: 19877741
DOI: 10.2165/11315570-000000000-00000 -
Drugs 2009Anidulafungin is an antifungal drug belonging to the echinocandin class with a potent in vitro fungicidal activity against a wide range of Candida species, including C.... (Review)
Review
Anidulafungin is an antifungal drug belonging to the echinocandin class with a potent in vitro fungicidal activity against a wide range of Candida species, including C. glabrata and C. krusei. Anidulafungin is also active in vitro against moulds belonging to the genus Aspergillus and some dematiaceous genera. Furthermore, anidulafungin demonstrates in vitro activity against Candida spp. growing as biofilms. Resistance to anidulafungin remains very rare based on recent epidemiological data. Paradoxical or trailing effects should be considered in echinocandin susceptibility testing. The in vitro activity profile of anidulafungin makes it a useful addition to the Italian antifungal armamentarium.
Topics: Anidulafungin; Animals; Antifungal Agents; Biofilms; Drug Resistance, Fungal; Echinocandins; Fungi; Humans; Mycoses
PubMed: 19877740
DOI: 10.2165/11315560-000000000-00000 -
Transplant Infectious Disease : An... Aug 2022
Topics: Anidulafungin; Antifungal Agents; Biliary Tract; Echinocandins; Humans; Liver Transplantation
PubMed: 35579962
DOI: 10.1111/tid.13848 -
Clinical Therapeutics Jun 2005Until recently, available treatment for serious fungal infections comprised amphotericin B and azoles, which have limitations. Renal toxicity is a major concern with... (Comparative Study)
Comparative Study Review
BACKGROUND
Until recently, available treatment for serious fungal infections comprised amphotericin B and azoles, which have limitations. Renal toxicity is a major concern with amphotericin B, while drug-drug interactions, hepatotoxicity, and skin rashes are the primary concerns with the azole medications. The development of the echinocandins, including caspofungin, has helped to fill the need for more efficacious antifungals that are useful across different patient populations and have a good safety profile. Anidulafungin is an echinocandin being developed to treat mucosal and invasive fungal infections.
OBJECTIVE
The aim of this report was to describe the pharmacodynamic and pharmacokinetic (PK) properties of anidulafungin.
METHODS
Data were identified using MEDLINE and National Library of Medicine Gateway searches for English-language literature (key words: anidulafungin, esophageal candidiasis, echinocandin, caspofungin, ravuconazole, voriconazole, posaconazole, micafungin, and fluconazole; years: 1996-2004), and from meeting abstracts of the American Society for Blood and Marrow Transplantation (Arlington Heights, Illinois), European Congress of Clinical Microbiology and Infectious Diseases (Basel, Switzerland), International Conference on Antimicrobial Agents and Chemotherapy (Washington, DC), and Infectious Diseases Society of America (Arlington, Virginia).
RESULTS
Anidulafungin has potent in vitro activity against Aspergillus and Candida spp, including those resistant to either fluconazole or amphotericin B. Results of several clinical trials imply that anidulafungin is effective in treating esophageal candidiasis (EC), candidemia, and invasive candidiasis (IC). In a Phase III, randomized, blinded clinical trial evaluating anidulafungin (50 mg/d) versus fluconazole (100 mg/d) for the treatment of EC, 97.2% and 98.9% of patients who received anidulafungin and fluconazole, respectively, showed evidence of cure or improvement (treatment difference, -1.6%; 95% CI, -4.1 to 0.8). In a Phase II study of candidasis and candidemia, anidulafungin showed success rates of 72%, 85%, and 83% in patients receiving the drug at dosages of 50, 75, or 100 mg/d, respectively. Studies evaluating the concomitant use of anidulafungin and either amphotericin, voriconazole, or cyclosporine did not show clinically significant drug-drug interactions or altered adverse-event (AE) profiles (P < 0.05). A population PK analysis showed no significant effect of age, race, concomitant medications, or renal or hepatic insufficiency on the PK properties of anidulafungin (P < 0.05).
CONCLUSIONS
Anidulafungin may offer a new option to treat serious fungal infections, such as EC, azole-refractory EC, candidemia, and IC. In addition, anidulafungin has been associated with no clinically significant drug-drug interactions and few treatment-related AEs. Anidulafungin may offer a new option in the management of serious and difficult-to-treat invasive fungal infections.
Topics: Anidulafungin; Animals; Antifungal Agents; Area Under Curve; Candida; Candidiasis; Echinocandins; Humans; Microbial Sensitivity Tests; Peptides, Cyclic
PubMed: 16117974
DOI: 10.1016/j.clinthera.2005.06.010 -
The Annals of Pharmacotherapy May 2014To report a case of a woman in whom alopecia appeared after several months of treatment with anidulafungin.
OBJETIVE
To report a case of a woman in whom alopecia appeared after several months of treatment with anidulafungin.
CASE SUMMARY
A 34-year-old woman with chronic femoral osteomyelitis with the presence of persistent suppuration, developed a Candida albicans infection, isolated in the fistula exudate cultures. After initial failures of single therapy with azoles, it was decided to administer fluconazole and anidulafungin 100 mg/d. One month after starting the treatment, the patient mentioned a greater hair loss than usual. At 3 months, the patient stopped taking the drug on noting the loss and easy falling out of her hair, with alopecia plaques 1 to 2 cm in size. At 2 months after stopping the anidulafungin, it was decided to restart combined antifungal treatment using micafungin and fluconazole; there was no mention of new or greater loss of hair. It was decided to change micafungin to anidulafungin again 90 days after starting treatment. In the first month of treatment, there appeared to be a reactivation in hair loss that later stabilized and improved.
DISCUSSION
Drug-induced hair loss is an adverse reaction that has been identified during different hair growth phases. It has been described for the azoles group and has not been associated with candins until now. Results of the causality analysis, using the probability scale established by Naranjo, found the relationship as probable.
CONCLUSIONS
Anidulafungin could be associated with hair loss. Physicians must be aware of this adverse effect in order to approach it properly and to detect possible nonadherence to treatment.
Topics: Adult; Alopecia; Anidulafungin; Antifungal Agents; Candidiasis; Drug Therapy, Combination; Echinocandins; Female; Fluconazole; Humans; Lipopeptides; Micafungin
PubMed: 24604921
DOI: 10.1177/1060028014524534 -
Expert Opinion on Investigational Drugs Sep 2004Anidulafungin (LY-303366, V-echinocandin trade mark, Vicuron Pharmaceuticals, Inc.) is a new echinocandin antifungal agent with broad spectrum activity against Candida... (Review)
Review
Anidulafungin (LY-303366, V-echinocandin trade mark, Vicuron Pharmaceuticals, Inc.) is a new echinocandin antifungal agent with broad spectrum activity against Candida and Aspergillus spp. Anidulafungin exhibits low toxicity, concentration-dependent fungicidal activity for Candida, and a prolonged post antifungal effect (> 12h). In vitro activity demonstrates excellent potency and spectrum versus azole-susceptible and -resistant Candida spp. and a low minimum effective concentration for Aspergillus spp. In vivo anidulafungin is fungicidal against Candida in neutropenic animal models of disseminated candidiasis. Against Candida anidulafungin exhibits concentration-dependent killing and clearance of residual fungal burden in target organs (liver, lung, spleen, kidney) and plasma/tissue concentrations exceed the minimum inhibitory and minimum fungicidal concentrations of the infecting organism throughout the dosing interval. Although the activity of anidulafungin in animal models of pulmonary or disseminated aspergillosis shows increased survival and improvement in the pulmonary infarct score, the effect on residual fungal burden and Aspergillus antigenemia determination does not indicate in vivo fungicidal activity. It seems that the major effect of anidulafungin and other echinocandins in vivo against Aspergillus spp. is the decrease in the angioinvasive potential of the organisms. Clinically, anidulafungin has been shown to be safe and effective in the treatment of oesophageal candidiasis and candidemia. Further clinical application of this new antifungal agent is warranted.
Topics: Anidulafungin; Animals; Antifungal Agents; Aspergillus; Candida; Echinocandins; Fungal Proteins; Humans; Peptides, Cyclic
PubMed: 15330749
DOI: 10.1517/13543784.13.9.1183 -
Expert Opinion on Pharmacotherapy Sep 2008Over the past two decades, the frequency and type of invasive fungal infections have increased greatly and thus have driven the need for new antifungal agents.... (Review)
Review
BACKGROUND
Over the past two decades, the frequency and type of invasive fungal infections have increased greatly and thus have driven the need for new antifungal agents. Anidulafungin is the newest addition to the echinocandin armamentarium.
OBJECTIVE
The intention of this review is to provide a drug evaluation of anidulafungin, including its spectrum of activity, pharmacokinetics, pharmacodynamics, clinical efficacy, adverse event profile, and its role in the treatment of invasive candidiasis.
METHODS
A PubMed search was performed to gather the most current and pertinent articles.
CONCLUSIONS
Clinical trials have demonstrated anidulafungin's efficacy and tolerability in invasive candidiasis. Anidulafungin is not associated with any drug-drug interactions and does not require dosage adjustment in patients with renal and/or hepatic impairment.
Topics: Anidulafungin; Antifungal Agents; Clinical Trials as Topic; Drug Resistance, Fungal; Echinocandins; Esophagus; Fungemia; Humans; Mycoses; Oropharynx
PubMed: 18710358
DOI: 10.1517/14656566.9.13.2339