A comparative evaluation of properties and clinical efficacy of the echinocandins.
With the increase in prevalence of fungal infections, newer antifungal agents are needed to effectively treat invasive disease, and at the same time minimize adverse effects from therapy. The echinocandins comprise a novel class of antifungals; their mechanism of action involves inhibiting 1,3-beta-D-glucan synthase, which is essential in cell wall synthesis for certain fungi. All three echinocandins are US FDA-approved for the treatment of esophageal candidiasis. Caspofungin and anidulafungin are licensed for the treatment of candidemia, and other select forms of invasive candidiasis. Micafungin is at present the only echinocandin approved for prophylaxis of fungal infections in hematopoietic stem cell transplants; whereas caspofungin is approved for empiric therapy of febrile neutropenia. Although all three echinocandins are active against Aspergillus, only caspofungin is presently approved for salvage therapy in invasive aspergillosis. Combination therapy with echinocandins plus other licensed antifungal therapy shows promise in treating invasive aspergillosis. This article will explore the similarities and differences among the echinocandins.
Kim
Rose
R
Cooper University Hospital/UMDNJ-Robert Wood Johnson Medical School Education and Research Building, Division of Infectious Diseases, Department of Medicine, Camden, NJ 08103, USA. kim-rose@cooperhealth.edu
Khachikian
Deborah
D
Reboli
Annette C
AC
D000077612:Anidulafungin; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000201:enzymology; D001230:Aspergillus / Q000187:drug effects / Q000201:enzymology / Q000254:growth & development; D002175:Candida / Q000187:drug effects / Q000201:enzymology / Q000254:growth & development; D002177:Candidiasis / Q000188:drug therapy / Q000201:enzymology; D000077336:Caspofungin; D004334:Drug Administration Schedule; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D054714:Echinocandins; D004791:Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D005964:Glucosyltransferases / Q000037:antagonists & inhibitors* / Q000378:metabolism; D006801:Humans; D055666:Lipopeptides; D008074:Lipoproteins / Q000494:pharmacology / Q000627:therapeutic use; D000077551:Micafungin; D009181:Mycoses / Q000188:drug therapy* / Q000201:enzymology / Q000382:microbiology; D010456:Peptides, Cyclic / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D004791:Enzyme Inhibitors; D055666:Lipopeptides; D008074:Lipoproteins; D010456:Peptides, Cyclic; D000077612:Anidulafungin; C036655:1,3-alpha-D-glucan synthase; D005964:Glucosyltransferases; D000077336:Caspofungin; D000077551:Micafungin