Anidulafungin has been prescribed in patients with candidemia, especially hepatic or renal dysfunction because of not undergoing metabolism in liver and kidney. The purpose of this study was to evaluate the safety of anidulafungin in these patient populations.
We retrospectively reviewed the electronic medical records of candidemia in 146 patients who were treated with anidulafungin for more than 7 days at Dong-A University Hospital from January 2012 to December 2017. We evaluated changes in AST, ALT, and total bilirubin (TB) between the start and end of anidulafungin therapy, and change in estimated GFR (eGFR), calculated by the Modification of Diet in Renal Disease (MDRD) study equations.
There were 101 patients with impaired liver function at the start of anidulafungin therapy (group A) and 57 with renal insufficiency (group B). In group A, 61 (60%) were male and the median age was 69 (20-88) years. The patients had solid tumor (51, 50%) and 26 (26%) were with liver disease. According to the Child-Pugh score, 54 (53%) patients were class B, 5 (5%) were class C. The median changes in AST, ALT and TB during anidulafungin therapy were -10 U/L, -8 U/L, -0.3 mg/dL (P = 0.023, P = 0.008, P = 0.013), respectively (Figure 1A). In group B, 35 (61%) were male and the median age was 71 (20-88) years. There were 21 (37%) patients with solid tumor and 30 (53%) had kidney disease. The median change of eGFR was +6.6 ml/min/1.73m2 (P < 0.001) (Figure 1B). Over 75% (ALT, AST, eGFR) and nearly 60% (TB) of patients had favorable changes (values were stable or improved) in hepatic or renal function during the anidulafungin therapy (Figure 2).
Anidulafungin was tolerable for the treatment of candidemia in patients with hepatic or renal damage.
Figure 1. Change of median values between SA and EA. (Figure 1A : AST, ALT and TB , Figure 1B : eGFR)
Figure 1A. Figure 1B.
Figure 2. Proportion of change patterns of AST, ALT, TB and eGFR between SA and EA.
J. Y. Kim,