Pharmacological properties and clinical efficacy of a recently licensed systemic antifungal, caspofungin.
Caspofungin, a semisynthetic derivative of the pneumocandin B(0), is the first licensed compound of a new class of antifungal agents, the echinocandins. It attacks the fungal cell by selective inhibition of the beta-(1,3)-d-glucan synthase, which is not present in mammalian cells. In vitro studies have indicated a potent fungicidal effect on Candida species, and in vivo studies in immunocompromised animals with invasive candidiasis demonstrated a favourable outcome. In randomized clinical trials in patients with oropharyngeal/oesophageal and invasive candidiasis, caspofungin was at least as effective as amphotericin B deoxycholate, yet showed a significantly superior safety profile. Of patients with invasive aspergillosis refractory to or intolerant of other antifungal agents, 45% showed a partial or complete response to caspofungin given as a salvage treatment. Also, it demonstrated comparable clinical efficacy but superior tolerability in the empirical antifungal therapy in neutropenic patients compared with liposomal amphothericin B. Caspofungin has an excellent tolerability and a low potential for drug interactions. Thus, caspofungin represents an interesting and clinically valuable new antifungal drug that broadens the available therapeutic armamentarium for the treatment of invasive fungal infections.
Abt. Hämatologie und Onkologie, Medizinische Klinik, Klinikum Ernst von Bergmann, Potsdam, Germany. gmaschmeyer@klinikumevb.de
Georg
G
Maschmeyer
Axel
A
Glasmacher
D000935:Antifungal Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D000077336:Caspofungin; D054714:Echinocandins; D005658:Fungi / Q000187:drug effects*; D006801:Humans; D055666:Lipopeptides; D009181:Mycoses / Q000188:drug therapy*; D010456:Peptides, Cyclic / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D000077336:Caspofungin