Vazquez Jose A, Sobel Jack D
Division of Infectious Diseases, Henry Ford Hospital, Wayne State University School of Medicine, Detroit, Michigan 48202, USA.
Clin Infect Dis. 2006 Jul 15;43(2):215-22. doi: 10.1086/505204. Epub 2006 Jun 9.
Until recently, the treatment available for serious fungal infections was composed of amphotericin B and azoles, and each class demonstrated significant limitations. Echinocandins are a new class of drugs that have shown promising results in treating a variety of fungal infections. Of these, anidulafungin is a novel echinocandin that appears to have several advantages over existing antifungals. It is unique because it slowly degrades in humans, undergoing a process of biotransformation rather than being metabolized. It has potent in vitro activity against Aspergillus and Candida species, including those resistant to fluconazole or amphotericin B. Results of several clinical trials indicate that anidulafungin is effective in treating esophageal candidiasis, including azole-refractory disease. The results of a recent study comparing fluconazole versus anidulafungin demonstrated the superiority of anidulafungin in the treatment of candidemia and invasive candidiasis (IC). Studies evaluating the concomitant use of anidulafungin and either amphotericin B, voriconazole, or cyclosporine did not demonstrate significant drug-drug interactions or adverse events. To date, anidulafungin appears to have an excellent safety profile. On the basis of early clinical experience, it appears that anidulafungin will be a valuable asset in the management of serious and difficult-to-treat fungal infections.
直到最近，用于治疗严重真菌感染的药物还只有两性霉素B和唑类药物，而这两类药物都有明显的局限性。棘白菌素是一类新型药物，已在治疗多种真菌感染中显示出有前景的结果。其中，阿尼芬净是一种新型棘白菌素，与现有的抗真菌药物相比似乎有几个优势。它很独特，因为它在人体内会缓慢降解，经历生物转化过程而非被代谢。它对曲霉属和念珠菌属具有强大的体外活性，包括对氟康唑或两性霉素B耐药的菌株。多项临床试验结果表明，阿尼芬净在治疗食管念珠菌病（包括对唑类耐药的疾病）方面有效。最近一项比较氟康唑和阿尼芬净的研究结果显示，阿尼芬净在治疗念珠菌血症和侵袭性念珠菌病（IC）方面更具优势。评估阿尼芬净与两性霉素B、伏立康唑或环孢素联合使用的研究未显示出显著的药物相互作用或不良事件。迄今为止，阿尼芬净似乎具有出色的安全性。基于早期临床经验，阿尼芬净似乎将成为治疗严重且难治性真菌感染的宝贵药物。
