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01-09-2004 | Leading Article

Newer Systemic Antifungal Agents

Pharmacokinetics, Safety and Efficacy

Authors: Helen W. Boucher, Andreas H. Groll, Christine C. Chiou, Dr Thomas J. Walsh

Published in: Drugs | Issue 18/2004

Abstract

The past few years have seen the advent of several new antifungal agents, including those of a new class and a new generation of an existing class. Caspofungin, the first available echinocandin, has greatly expanded the antifungal armamentarium by providing a cell wall-active agent with candidacidal activity as well as demonstrated clinical efficacy in the therapy of aspergillosis refractory to available therapy. In addition, in clinical trials, caspofungin had comparable efficacy to amphotericin B for candidaemia and invasive Candida infections. Caspofungin and two more recently introduced echinocandins, micafungin and anidulafungin, are available as intravenous formulations only and characterised by potent anti-candidal activity, as well as few adverse events and drug interactions.

Voriconazole, the first available second-generation triazole, available in both intravenous and oral formulations, has added a new and improved therapeutic option for primary therapy of invasive aspergillosis and salvage therapy for yeasts and other moulds. In a randomised trial, voriconazole demonstrated superior efficacy and a survival benefit compared with amphotericin B followed by other licensed antifungal therapy. This and data from a noncomparative study led to voriconazole becoming a new standard of therapy for invasive aspergillosis. Voriconazole has several important safety issues, including visual adverse events, hepatic enzyme elevation and skin reactions, as well as a number of drug interactions. Posaconazole, only available orally and requiring dose administration four times daily, shows encouraging efficacy in difficult to treat infections due to zygomycetes. Ravuconazole, available in both intravenous and oral formulations, has broad-spectrum in vitro potency and in vivo efficacy against a wide range of fungal pathogens. Clinical studies are underway.

Despite the advances offered with each of these drugs, the morbidity and mortality associated with invasive fungal infections remains unacceptable, especially for the most at-risk patients. For individuals with severe immunosuppression as a result of chemotherapy, graft-versus-host disease and its therapy, or transplantation, new drugs and strategies are greatly needed.

The use of trade names is for product identification purposes only and does not imply endorsement.

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Title: Newer Systemic Antifungal Agents
Pharmacokinetics, Safety and Efficacy
Authors: Helen W. Boucher
Andreas H. Groll
Christine C. Chiou
Dr Thomas J. Walsh
Publication date: 01-09-2004
Publisher: Springer International Publishing
Published in: Drugs / Issue 18/2004
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI: https://doi.org/10.2165/00003495-200464180-00001

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Newer Systemic Antifungal Agents

Pharmacokinetics, Safety and Efficacy

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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