Evaluating the Efficacy and Safety of Anidulafungin and Caspofungin in Invasive Candida Infections in Intensive Care Units in India: A Prospective, Observational, Multicenter, Open-Label Study

TL;DR

This study compared the effectiveness and safety of two antifungal drugs in treating invasive Candida infections in ICU patients in India.

Contribution

The study provides real-world evidence on the efficacy of anidulafungin and caspofungin in Indian ICU settings.

Findings

Anidulafungin had a 46.5% global response rate, while caspofungin had a 47.1% global response rate.

Caspofungin showed higher microbiological success (70.7%) compared to anidulafungin (34.9%).

Abstract

Background: Invasive Candida infections are a significant concern in ICU patients, with mortality rates ranging from 30-50%. This study aimed to assess the demographic and risk factors, as well as the safety and efficacy of anidulafungin and caspofungin in treating invasive Candida infections in ICU patients.

Methodology: This prospective, observational, multicenter, open-label study was conducted across four hospitals in India to evaluate the safety and efficacy of anidulafungin and caspofungin in adult ICU patients with confirmed or suspected invasive Candida infections. Patients aged ≥18 years were treated with either anidulafungin or caspofungin. Data were collected on sociodemographic characteristics, medical history, medications, and clinical outcomes, including hospital stay, treatment duration, and clinical and microbiological responses.  Efficacy assessment is based on clinical and microbiologic success. Clinical success is defined as the resolution of signs and symptoms of invasive candidiasis, and microbiologic success is defined as the eradication of Candida species present at baseline, as determined on follow-up culture. A positive global response refers to both clinical and microbiologic success.

Results: A total of 44 patients received anidulafungin and 18 received caspofungin. The mean age for anidulafungin-treated patients was 61.1±14.1 years, while for caspofungin-treated patients, it was 56.6±14.3 years. Anidulafungin achieved a clinical success rate of 34.9%, microbiological success of 34.9%, and a global response rate of 46.5%. Caspofungin showed clinical success of 50%, microbiological success of 70.7%, and a global response rate of 47.1%.

Conclusions: The study showed that anidulafungin is effective in treating invasive candida infections and could be an equivalent alternative in terms of efficacy.