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Cited by 85Antifungal resistance and susceptibilityFungal Infections and StudiesFungal Plant Pathogen Control

Caspofungin: first approved agent in a new class of antifungals

Johnson, Melissa D, Perfect, John R·2003·Expert Opinion on Pharmacotherapy
DOI 10.1517/14656566.4.5.807
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Abstract

Caspofungin (Cancidas, Merck & Co. Inc.) is the first echinocandin antifungal agent to gain FDA-approval for use in the US. It has excellent clinical activity against Candida spp. and Aspergillus spp. but lacks significant activity against Cryptococcus neoformans. Caspofungin may have some activity against dimorphic fungi such as Histoplasma capsulatum and Coccidioides immitis, but no clinical data is available for treatment of these infections. Caspofungin has demonstrated poor activity against most filamentous fungi in vitro. Several clinical trials have demonstrated its efficacy in the treatment of oropharyngeal, oesophageal and invasive candidiasis, as well as invasive aspergillosis. As a result of caspofungin's unique mechanism of action, and the high morbidity and mortality of invasive fungal infections, there is considerable interest in using this new antifungal agent as part of a combination antifungal therapy. In vitro studies and small case series indicate that caspofungin does not appear to be antagonistic when combined with other antifungals, such as itraconazole, voriconazole or amphotericin B against Aspergillus spp. Caspofungin exerts concentration-dependent killing effects in many different in vitro and animal models of disseminated fungal infection. The usual daily dose is 50 mg/day i.v. following a 70 mg i.v. loading dose. However, higher caspofungin doses have been safely administered and up to 70 mg/day can be administered for patients who fail to respond to lower doses. Caspofungin has an excellent safety profile with reduced toxicities, compared to other licensed antifungal agents. Fever, thrombophlebitis, headache and liver enzyme elevations were the most common drug-related side effects reported in clinical trials so far. Additional data are needed to document its safety in long-term use, and with higher doses in patients with invasive fungal infections. Caspofungin is a promising agent as first-line therapy for invasive candidiasis, and as salvage therapy for invasive aspergillosis. However, more clinical data are needed to define its role as primary therapy for invasive aspergillosis, and its role in combination antifungal therapy.

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  • Echinocandins were first discovered in the 1970s, developed mostly during the 1990s, and caspofungin, the first FDA-approved member, entered the market in the early 2000s.

    “Echinocandins, the newest class of antifungals, were first discovered in the 1970s, although their development took place mostly during the 1990s, and it was not until the early 2000s when caspofungin, the first FDA-approved member of this class, entered the market [25,30,31].”

    From Antifungal therapy of Candida biofilms: Past, present and future (2023) · cites this paper as [31]

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Authors
Johnson, M. D., & Perfect, J. R.
Affiliations
Duke University (US)
ORCID
Venue
Expert Opinion on Pharmacotherapy
Publisher
Informa Healthcare
Published
2003-05
Volume
4
Issue
5
Pages
807-823
ISSN
  • 1465-6566 (ISSN-L)
  • 1744-7666
DOI
10.1517/14656566.4.5.807
OpenAlex
W1995291620
Cited by
85
References
59
Citations by year
2026: 1 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 4 · 2017: 1 · 2015: 2 · 2012: 2
FWCI
5.44
Type
journal article
Language
en
Open access
closed
Locations
  • Expert Opinion on Pharmacotherapy (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Allergy and Infectious Diseases (K23AI051537, L30 AI057128, P0 AI44975, 1K23 AI51537-01)
  • National Center for Research Resources (M01RR000030)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
  • Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Keywords
caspofungin, echinocandins, antifungal agents, invasive candidiasis, invasive aspergillosis, Cryptococcus neoformans, combination antifungal therapy, drug interactions, drug safety, dose escalation, oropharyngeal candidiasis, esophageal candidiasis, dimorphic fungi, Histoplasma capsulatum, Coccidioides immitis, filamentous fungi
MeSH terms
Caspofungin, Adult, Aged, Animals, Anti-Bacterial Agents, Antifungal Agents, Aspergillosis, Biological Availability, Candidiasis, Disease Models, Animal, Drug Interactions, Female, Half-Life, Humans, Male, Microbial Sensitivity Tests, Mycoses, Peptides, Peptides, Cyclic, Tissue Distribution, Area Under Curve, Echinocandins, Lipopeptides

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