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Pharmacology and metabolism of anidulafungin, caspofungin and micafungin in the treatment of invasive candidosis - review of the literature
Open accessAbstract
Echinocandins represent the newest class of antifungal agents. Currently, three echinocandins, anidulafungin, caspofungin and micafungin are licensed for clinical use in various indications. They act as inhibitors of β-(1,3)-glucan synthesis in the fungal cell wall and have a favorable pharmacological profile. They have a broad spectrum of activity against all Candida species. Higher MIC's have been observed against C. parapsilosis and C. guilliermondii. Data from clinical trials for invasive Candida infections / candidaemia suggest that the clinical outcome of patients treated with either drug may be very similar. A comparison has been done between caspofungin and micafungin but for anidulafungin a comparative trial with another echinocandin is still lacking. All three drugs are highly effective if not superior to treatment with either fluconazole or Amphotericin B, particularly in well-defined clinical settings such as invasive Candida infections, Candida oesophagitis and candidaemia. Differences between the three echinocandins with regard to the route of metabolism, requirement for a loading dose, dose adjustment in patients with moderate to severe hepatic disease and different dosing schedules for different types of Candida infections have to be considered. Relevant drug-drug interactions of Caspofungin and Micafungin are minimal. Anidulafungin has no significant drug interactions at all. However, echinocandins are available only for intravenous use. All three agents have an excellent safety profile.
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“It is highly soluble in aqueous systems and has a half-life of over 130 h in humans, compared to 24, 9–11, 10–17 h half-lives of anidulafungin, caspofungin, and micafungin, respectively (Kofla and Ruhnke, 2011; Sandison et al., 2017).”
From Fungal Cell Wall: Emerging Antifungals and Drug Resistance. (2019) · cites this paper as Kofla and Ruhnke, 2011
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“Finally, the last group includes compounds which are derived from semisynthetic natural products, such as compounds derived from echinocandins: micafungin sodium, anidulafungin, caspofungin acetate, and pneumocandin. These agents showed improved properties over the parental compounds [50, 141].”
From Candida Infections, Causes, Targets, and Resistance Mechanisms: Traditional and Alternative Antifungal Agents (2013) · cites this paper as [141]
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Nosocomial Bloodstream Infections in United States Hospitals: A Three‐Year Analysis
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Anidulafungin versus Fluconazole for Invasive Candidiasis
Reboli, A. C., Rotstein, C., Pappas, P. G., Chapman, S. W., Kett, D. H., Kumar, D., Betts, R., Wible, M., Goldstein, B. P., Schranz, J., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa066906 · Cited by 894
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Kuse, E.-R., Chetchotisakd, P., da Cunha, C. A., Ruhnke, M., Barrios, C., Raghunadharao, D., Sekhon, J. S., Freire, A., Ramasubramanian, V., Demeyer, I., et al. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60605-9 · Cited by 692
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Metadata
- Authors
- Kofla, G., & Ruhnke, M.
- Affiliations
- Charité – Universitätsmedizin Berlin (DE)
- Corresponding author
- Ruhnke, M
- Venue
- European Journal of Medical Research
- Published
- 2011
- Volume
- 16
- Issue
- 4
- Pages
- 159
- ISSN
- 0949-2321 (ISSN-L)
- 2047-783X
- PMC
- PMC3352072
- OpenAlex
- W2072639782
- Cited by
- 153
- References
- 78
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 8 · 2023: 14 · 2022: 14 · 2021: 12 · 2020: 16 · 2019: 14 · 2018: 10 · 2017: 13 · 2016: 10 · 2015: 9 · 2014: 8 · 2013: 6 · 2012: 2
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- European journal of medical research (publishedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Fungal Plant Pathogen Control
- Keywords
- anidulafungin, caspofungin, micafungin, echinocandins, invasive candidiasis, candidemia, Candida parapsilosis, Candida guilliermondii, pharmacokinetics, drug-drug interactions, liver dysfunction, loading dose, dosing regimen, fluconazole, amphotericin B
- MeSH terms
- Caspofungin, Micafungin, Anidulafungin, Antifungal Agents, Drug Interactions, Humans, Molecular Structure, Biofilms, Drug Resistance, Fungal, Echinocandins, Lipopeptides, Candidiasis, Invasive
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