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Curr Infect Dis Rep (2011) 13:517527
DOI 10.1007/s11908-011-0216-6
FUNGAL INFECTIONS (ANDREAS H. GROLL, SECTION EDITOR)
Current Role of Echinocandins in the Management of Invasive Aspergillosis
Magorzata Mikulska & Claudio Viscoli
Published online: 23 September 2011# Springer Science+Business Media, LLC 2011
Abstract Echinocandins are parenteral antifungals with a unique site of action targeting the cell wall synthesis. There are three molecules available, anidulafungin, caspofungin, and micafungin, which have fungicidal and fungistatic activity against Candida and Aspergillus, respectively, and an excellent safety profile. There is consistent proof of clinical activity against Aspergillus for caspofungin, while less is known for micafungin and even lees for anidulafungin. Micafungin and caspofungin have been successfully used in targeted treatment of aspergillosis, prophylaxis, and empirical therapy, both as monotherapy and in combination with other antifungals. Caspofungin is approved for empirical therapy of febrile neutropenia and salvage treatment of invasive aspergillosis, whereas micafungin is only licensed for antifungal prophylaxis in stem cell transplantation.
Keywords Echinocandins . Anidulafungin . Caspofungin . Micafungin . Invasive fungal infection . Antifungal prophylaxis . Pre-emptive treatment . Aspergillus . Transplant . Glucan
Introduction
Echinocandins are a new class of antifungals that share a unique mechanism of action. While other antifungals such as polyenes and azoles target the fungal cell membrane, the echinocandins inhibit the synthesis of (1,3)-beta-D-glucan,
an important component of the fungal cell wall. Currently, there are three echinocandins approved both by the US and European Agencies (Food and Drug Administration, FDA, and European Medicines Agency, EMA) [16]. Caspofungin was the first echinocandin approved and marketed (in 2001), and therefore it has been the most widely studied and used. Indeed, caspofungin is licensed for treatment of invasive candidiasis (including candidemia) in adult or pediatric patients, for salvage therapy of invasive aspergillosis (IA) and for empirical therapy for presumed fungal infections in febrile, neutropenic patients [1, 2]. Anidulafungin was first approved in 2006 in the US and in 2007 in Europe, and is licensed for the treatment of invasive candidiasis in non-neutropenic patients [3, 4]. Finally, micafungin was licensed in Japan in 2002, but it received the US approval in 2005, for the indications of treatment of invasive candidiasis and prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation (HSCT) [5]. In Europe, micafungin was...