Abstract
BackgroundCandidemia is a significant cause of morbidity and mortality in hospitalized patients, particularly in Asia. Anidulafungin has been reported to be an effective treatment for candidemia in Western populations, but little is known about its efficacy in Asian patients, where the clinical presentation and epidemiology may be different.MethodsAn open-label study of anidulafungin for the treatment of candidemia was recently conducted in several Asian countries. Treatment was initiated with intravenous anidulafungin, given for at least 5 days, with the option to complete treatment with oral voriconazole. The primary endpoint was global (clinical and microbiological) response, and the primary analysis was the proportion of patients in the modified intent-to-treat population with successful global response at the end of therapy. Secondary analyses included proportion with successful global response in clinically relevant patient subgroups. The safety and tolerability profile of anidulafungin and voriconazole in this population was also investigated.ResultsForty-three patients were studied, including 42 in the modified intent-to-treat population. Eighteen patients were > 65 years, the largest age subgroup, and 21 had central venous catheters. The most common Candida species causing infection were C. tropicalis (n = 18) and C. albicans (n = 10). In the primary analysis, 73.8% had a successful global response at end of therapy. Success rates in subgroups were: 72.2% for C. tropicalis and 71.4% for C. albicans infection, 58.8% for patients > 65 years, and 81.0% for patients with central venous catheters. Safety and tolerability were comparable with the known profiles for anidulafungin (and voriconazole).ConclusionsAlthough the epidemiology of Candida infections was different in this open-label study, the efficacy of anidulafungin in Asian patients with documented candidemia was consistent with previous studies in Western populations. No new safety concerns were identified.Trial registrationhttp://www.clinicaltrials.gov identifier NCT00537329
Highlights
Candidemia is a significant cause of morbidity and mortality in hospitalized patients, in Asia
Mortality varies according to patient age, pre-existing comorbidities, and the causative Candida species; the highest mortality rates are observed with C. krusei, followed by C. tropicalis and C. glabrata [2,8]
The efficacy and safety profile of anidulafungin was in line with that previously observed in Western populations
Summary
Candidemia is a significant cause of morbidity and mortality in hospitalized patients, in Asia. Crude mortality rates associated with C/IC are substantial, ranging from 30% to 81% according to recent reports [2,4]. Mortality varies according to patient age, pre-existing comorbidities, and the causative Candida species; the highest mortality rates are observed with C. krusei, followed by C. tropicalis and C. glabrata [2,8]. A retrospective review of admissions to a Korean intensive care unit reported an incidence of candidemia of 9.1 cases per 1000 admissions, with a notably high crude mortality of 96%, due to a high proportion of patients with malignancy [9]. Four centers in Taiwan reported crude mortality ranging from 43.1% to 60.7% [10], and a tertiary care center in North India reported a decrease in mortality rate from 72.2% to 47% over a 5-year period as awareness of disease prevalence increased [11]
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