Echinocandins for management of invasive candidiasis in patients with liver disease and liver transplantation

Siang Fei Yeoh,1 Tae Jin Lee,2 Ka Lip Chew,3 Stephen Lin,4 Dennis Yeo,5 Sajita Setia5 1Department of Pharmacy, National University Health System, Singapore, Singapore; 2Department of Pharmacy, National University of Singapore, Singapore, Singapore; 3Department of Laboratory Medicine, National University Hospital, Singapore, Singapore; 4Global Medical Affairs, Asia-Pacific region, Pfizer, Hong Kong, People’s Republic of China; 5Medical Affairs, Pfizer Pte. Ltd., Singapore, Singapore Abstract: Candida species remains one of the most important causes of opportunistic infections worldwide. Invasive candidiasis (IC) is associated with considerable morbidity and mortality in liver disease (LD) patients if not treated promptly. Echinocandins are often recommended as a first-line empirical treatment for managing IC and can especially play a critical role in managing IC in LD patients. However, advanced LD patients are often immunocompromised and critically ill. Hence altered pharmacokinetics, drug interactions as well as tolerance issues of antifungal treatments are a concern in these patients. This comprehensive review examines the epidemiology, risk factors and diagnosis of IC in patients with LD and evaluates differences between three available echinocandins for treating this group of patients. Keywords: anidulafungin, caspofungin, candidemia, micafungin