Anidulafungin is the most recently approved compound of the
echinocandin antifungal class. Its mode of action is the noncompetitive inhibition of β-(1,3)-D-glucan synthesis. Potent fungicidal activity has been demonstrated against many Candida spp., including non-albicansCandida spp. and
fluconazole-resistant strains, as well as fungistatic activity against Aspergillus spp. Owing to low oral bioavailability, it can only be administered intravenously.
Anidulafungin is not metabolized by the liver and renal clearance is negligible, thus rendering dosage adjustments in patients with impaired hepatic or renal function unnecessary. Due to lack of interference with the
cytochrome P450 pathway, it displays minimal
drug-drug interaction.
Anidulafungin has been approved by the US FDA for the treatment of esophageal and
invasive candidiasis after clinical trials demonstrated its noninferiority to
fluconazole. In September 2007,
anidulafungin gained EMEA approval for the treatment of
invasive candidiasis in adult non-neutropenic patients. For those with invasive or noninvasive
candidiasis with resistance or intolerance to
fluconazole in particular, as well as those requiring antifungal medication, that
anidulafungin does not interact with concomitant medication means it may be regarded as a safe and efficacious treatment option. Promising results from animal models and experience with the other
echinocandins indicate several potential lines of investigation: invasive
aspergillosis, prophylaxis and treatment of transplant patients, and empirical treatment in patients with
febrile neutropenia. Significant differences in clinical efficacy or safety favoring
anidulafungin over the other
echinocandins are yet to be discovered.