Hepatotoxicity Patterns of Anidulafungin and Fluconazole in the Management of Candida Infections: A Comparative Study among Hospitalized Patients

Abstract

Hepatotoxicity can potentially arise in hospitalized patients with Candida infections due to antifungal medications. Ongoing research has focused on the hepatotoxicity profiles of fluconazole and anidulafungin. Nevertheless, a limited number of studies have directly compared the hepatotoxicity of these two antifungals. This study compares the hepatotoxic effects of anidulafungin and fluconazole in patients hospitalized with Candida infections. This retrospective study was conducted at the Prince Mohamed Bin Abdelaziz Hospital in Saudi Arabia to compare the hepatotoxicity of fluconazole and anidulafungin in patients with Candida infection. The liver function test results were analyzed using linear mixed models, with adjustments made for confounding factors. The investigation comprised 202 cases, of which 85 (42%) were treated with fluconazole and 117 (58%) was treated with anidulafungin—mortality and prevalence of candidemia and septic shock in the Anidulafungin group (p 0.001). There was no significant difference between the two groups regarding age, gender, duration of treatment, or concomitant use of hepatotoxic drugs. Analyses utilizing Linear Mixed-Effects Models revealed higher alanine aminotransferase (ALT) (p = 0.001) and aspartate aminotransferase (AST) (p = 0.001) levels in the Anidulafungin group initially; however, after adjusting for covariates, these differences were no longer statistically significant. The levels of alkaline phosphatase (ALP) and gamma-glutamyl transferase (GTT) did not differ significantly between groups after controlling for confounding variables. However, the Anidulafungin group had substantially higher bilirubin levels than the Fluconazole group, and this difference remained significant after adjusting for potential confounding variables (p = 0.022). In summary, this study contributes to understanding the relative hepatotoxicity of anidulafungin and fluconazole. After controlling for confounding variables, it was found that there were no significant differences in liver enzyme levels between the two groups. When assessing the hepatotoxicity of these antifungal agents, it is imperative to consider the individual patient characteristics, underlying health conditions, and concurrent administration of other hepatotoxic medications.