Anidulafungin is an antimycotic agent with fungicidal activity against Candida species and activity against regions of active cell growth of the hyphae of Aspergillus fumigatus. It exerts its effect through selective inhibition of 1,3-beta-D glucan synthase, an enzyme present in fungal but not mammalian cells, thereby inhibiting the formation of 1,3-beta-D glucan, an essential component of the fungal cell wall.
Anidulafungin was evaluated in a double-blind, non-inferiority study1 comparing it with fluconazole for the treatment of candidaemia and other forms of invasive candidiasis in patients aged 16 years and over (n=245).
Patients were randomised to intravenous anidulafungin (200mg on day one then 100mg daily, n=127) or intravenous fluconazole (800mg on day one then 400mg daily, n=118).
The primary endpoint was global success at the end of intravenous therapy, defined as both clinical success (resolution of signs and symptoms of invasive candidiasis and no need for additional systemic antifungal therapy) and microbiological success (eradication of Candida species present at baseline, as determined on follow-up culture, or the presumed eradication if culture data not available for a patient with a successful clinical response).
Overall, a successful response was achieved in 75.6 per cent of patients in the anidulafungin group compared with 60.2 per cent of those in the fluconazole group.
In patients with candidaemia only, 75.9 per cent in the anidulafungin group and 61.2 per cent in the fluconazole group achieved a successful response. Similarly, among patients with other forms of invasive candidiasis a greater proportion of patients in the anidulafungin group achieved a successful response than in the fluconazole group.
1. Reboli A, Rotstein C, Pappas P et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med 2007: 356: 2472–82.
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