Invasive fungal infections are difficult to eradicate especially in immuno-compromised host.
Amphotericin B and
voriconazole have been the mainstay of treatment but both have significant toxicity.
Caspofungin belongs to a new class of
antifungal agents, the
echinocandins. It acts on the fungal cell wall by selective inhibition of beta-(1,3)-D-glucan syntheses, which is not present in mammalian cells. In vitro data and experimental studies have demonstrated that it has antifungal activity against yeasts of the genus Candida (including those resistant to
amphotericin B and
azoles), severe species of filamentous fungi, including
aspergillosis and certain dimorphic fungi. As an empirical antifungal
therapy in neutropenic patients, it has comparable clinical efficacy but superior tolerability compared with
liposomal amphotericin B. In patients with
invasive candidiasis, it is as effective as
amphotericin B deoxycholate. In addition, it showed a significantly superior safety profile. Same has been shown in patients with oropharyngeal/oesophageal
candidiasis. In patients with invasive
aspergillosis refractory to or intolerant to other
antifungal agents, 45% showed a partial or complete response to
Caspofungin given as a
salvage treatment.
Caspofungin is cidal for all Candida species and is static against Aspergillus species. It also possesses activity against Pneumocystis jiroveci. In vitro and in animals,
Caspofungin shows additive or synergic antifungal activity with
amphotericin B and
triazoles. Recently, it's use in paediatric patients, including after
bone marrow transplantation, has also been shown to be safe. With compare to other
antifungal agents known to be effective in systemic
fungal infections,
Caspofungin has the best safety profile, tolerability with very low potential for drug interactions. This makes
Caspofungin an interesting and extremely valuable new
antifungal agent that broadens the available therapeutic armamentarium for the treatment of systemic
fungal infections.