Pharmacokinetics of anidulafungin during albumin dialysis

Aguilar, Gerardo; Azanza, J. R.; Sádaba, Belén; Badenes, Rafael; Ferrando, Carlos; Delgado, Carlos; Hernández, Javier; Parra, M.A.; Puig, Jaume; Carbonell, J; Navarro, David; Belda, F. Javier

doi:10.1186/cc13805

Cited by 11 publications

(8 citation statements)

References 4 publications

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“…Differences in plasma concentrations and pharmacokinetic parameters of anidulafungin determined in the different studies can be observed in this table. Analysis of the results revealed that the concentrations found in the present study patients are quite similar to those found in critically ill patients, as reported by van Wanrooy et al in a previous study (van Wanrooy et al, 2014), but are lower than those reported by other authors in the same population (Aguilar et al, 2014a;Aguilar et al, 2014b;Liu et al, 2013;Brüggemann et al, 2017). However, as published by several authors, exposure to anidulafungin is clearly lower in critically ill patients as compared to healthy subjects (Dowell et al, 2005;Dowell et al, 2007).…”

Section: Resultssupporting

confidence: 88%

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Pharmacokinetics of anidulafungin in critically ill patients with Candida peritonitis

Civantos

Marcos

Perea

et al. 2019

International Journal of Infectious Diseases

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Objective: To describe the pharmacokinetic (PK) profile of anidulafungin and to evaluate its concentration in the peritoneal fluid (PF) of patients suspected of suffering from peritoneal infection undergoing abdominal surgery, in order to ensure that therapeutic levels are achieved within the peritoneal cavity. Methods:A descriptive, open, prospective, observational, multicentre and non-interventional study was performed. Anidulafungin was used at conventional doses. Blood and PF samples were obtained on day 2 of treatment or on any of the following days. Results: A total of 31 patients in a serious clinical condition, as demonstrated by high mean clinical severity scale scores (APACHE II and SOFA scores), were included in the study. The mean area under the curve (AUC) in PF was 30% (31 AE 19%) of that determined in the plasma and the maximum concentration (Cmax) reached in PF (mg/l) was close to 1 (0.9 AE 0.5). No adverse effects were observed in any of the 31 patients.Conclusions: Anidulafungin at conventional doses reaches PF concentrations that exceed the minimum inhibitory concentration of the usual Candida spp, which explains the proven efficacy of this echinocandin in the treatment of Candida peritonitis in critically ill patients.

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Section: Resultssupporting

confidence: 88%

“…Anidulafungin is not dialyzable and can therefore be administered without considering haemodialysis times. In patients requiring external clearance techniques, no PK changes have been described (De Rosa et al, 2013;Burkhardt et al, 2009;Aguilar et al, 2014a;Aguilar et al, 2014b).…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics of anidulafungin in critically ill patients with Candida peritonitis

Civantos

Marcos

Perea

et al. 2019

International Journal of Infectious Diseases

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“…However, the most likely explanation for this lower exposure is an increase in volume of distribution caused by ascites and edema [88]. In a single severely hepatic impaired patient requiring albumin dialysis, anidulafungin PK did not seem to be affected [89].…”

Section: Anidulafunginmentioning

confidence: 98%

Impact of special patient populations on the pharmacokinetics of echinocandins

Muilwijk¹,

Lempers²,

Burger³

et al. 2015

Expert Review of Anti-infective Therapy

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Echinocandins belong to the class of antifungal agents. Currently, three echinocandin drugs are licensed for intravenous treatment of invasive fungal infections: anidulafungin, caspofungin and micafungin. While their antifungal activity overlaps, there are substantial differences in pharmacokinetics (PK). Numerous factors may account for variability in PK of echinocandins including age (pediatrics vs adults), body surface area and body composition (normal weight vs obesity), disease status (e.g., critically ill and burn patients) and organ dysfunction (kidney and liver impairment). Subsequent effects of altered exposure might impact efficacy and safety. Knowledge of PK behavior is crucial in optimal clinical utilization of echinocandin in a specific patient or patient population. This review provides up-to-date information on PK data of anidulafungin, caspofungin and micafungin in special patient populations. Patient populations addressed are neonates, children and adolescents, obese patients, patients with hepatic or renal impairment, critically ill patients (including burn patients) and patients with hematological diseases.

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“…Renal replacement therapy by continuous veno-venous haemodiafiltration or continuous veno-venous haemofiltration did not affect anidulafungin pharmacokinetics, and there was no relevant extracorporeal CL [ 341 – 343 ]. In a patients with liver failure treated with albumin dialysis, anidulafungin exposure was in the normal range although t ½ was only 18 h [ 344 ]. A patient treated with veno-venous ECMO for acute respiratory distress syndrome presented unchanged anidulafungin kinetics [ 345 ].…”

Section: Anidulafunginmentioning

confidence: 99%

Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients

2017

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IntroductionBecause of the high mortality of invasive fungal infections (IFIs), appropriate exposure to antifungals appears to be crucial for therapeutic efficacy and safety.Materials and methodsThis review summarises published pharmacokinetic data on systemically administered antifungals focusing on co-morbidities, target-site penetration, and combination antifungal therapy.Conclusions and discussionAmphotericin B is eliminated unchanged via urine and faeces. Flucytosine and fluconazole display low protein binding and are eliminated by the kidney. Itraconazole, voriconazole, posaconazole and isavuconazole are metabolised in the liver. Azoles are substrates and inhibitors of cytochrome P450 (CYP) isoenzymes and are therefore involved in numerous drug–drug interactions. Anidulafungin is spontaneously degraded in the plasma. Caspofungin and micafungin undergo enzymatic metabolism in the liver, which is independent of CYP. Although several drug–drug interactions occur during caspofungin and micafungin treatment, echinocandins display a lower potential for drug–drug interactions. Flucytosine and azoles penetrate into most of relevant tissues. Amphotericin B accumulates in the liver and in the spleen. Its concentrations in lung and kidney are intermediate and relatively low myocardium and brain. Tissue distribution of echinocandins is similar to that of amphotericin. Combination antifungal therapy is established for cryptococcosis but controversial in other IFIs such as invasive aspergillosis and mucormycosis.

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Pharmacokinetics of anidulafungin during albumin dialysis

Cited by 11 publications

References 4 publications

Pharmacokinetics of anidulafungin in critically ill patients with Candida peritonitis

Pharmacokinetics of anidulafungin in critically ill patients with Candida peritonitis

Impact of special patient populations on the pharmacokinetics of echinocandins

Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients

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