Abstract
To compare the risk of severe hepatotoxicity with anidulafungin versus caspofungin and micafungin in hospitalized adults. This retrospective cohort study combined data from two large US- based hospital electronic medical record databases. Severe hepatotoxicity was a Grade ≥ 3 liver function test (LFT) post-echinocandin initiation. Adjusted incidence rate ratios (IRRs) were estimated for anidulafungin versus caspofungin and micafungin, overall and in patients with normal baseline LFT (Grade 0). Treatments included anidulafungin (n = 1700), caspofungin (n = 4431), or micafungin (n = 6547). The proportions with LFT Grade ≥ 3 pre-echinocandin initiation were: anidulafungin 40.4% versus caspofungin 25.9% (p < 0.001) and micafungin 25.6% (p < 0.001). Rates of severe underlying diseases or comorbidities were: critical care admissions: 75.3% versus 52.6 and 48.6%; and organ failures: 69.4% versus 46.7 and 51.5%. Adjusted IRRs of severe hepatotoxicity for anidulafungin versus caspofungin and micafungin were 1.43 (p = 0.002) and 1.19 (p = 0.183) overall, and 0.88 (P = 0.773) and 0.97 (P = 0.945) for normal baseline LFT, respectively. Accounting for confounders, severe hepatotoxicity risk was not significantly different across echinocan...Continue Reading
References
Jan 1, 1987·Journal of Chronic Diseases·M E CharlsonC R MacKenzie
Apr 1, 1983·Statistics in Medicine·O S Miettinen
Aug 13, 2004·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Hilmar WisplinghoffMichael B Edmond
Oct 15, 2005·Medical Care·Hude QuanWilliam A Ghali
Jan 11, 2007·Archives of Internal Medicine·Philippe Gabriel StegUNKNOWN GRACE Investigators
Mar 24, 2010·Antimicrobial Agents and Chemotherapy·Jiun-Ling WangK Arnold Chan
May 18, 2010·Medical Care·M Alan BrookhartSebastian Schneeweiss
Aug 26, 2010·JAMA : the Journal of the American Medical Association·Bruce M Psaty, David S Siscovick
Sep 9, 2010·Expert Opinion on Drug Metabolism & Toxicology·Effie L Kuti, Joseph L Kuti
Feb 15, 2011·Infectious Disease Clinics of North America·George J Alangaden
Apr 14, 2011·European Journal of Medical Research·G Kofla, Markus Ruhnke
Apr 14, 2011·European Journal of Medical Research·Andreas Glöckner
Jun 1, 2011·Drug Discovery Today·Minjun ChenWeida Tong
Feb 14, 2012·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·J M AguadoUNKNOWN TOSCANA Study Group
Dec 21, 2012·Science Translational Medicine·Gordon D BrownTheodore C White
Aug 28, 2015·The Journal of Antimicrobial Chemotherapy·Dong Sik JungDimitrios P Kontoyiannis
Jan 27, 2016·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Peter G PappasJack D Sobel
Jun 9, 2016·Expert Review of Anti-infective Therapy·Frank P TverdekDimitrios P Kontoyiannis
Jul 14, 2016·The Journal of Antimicrobial Chemotherapy·Sebastian SchneeweissAlexander M Walker
Sep 17, 2016·BMC Infectious Diseases·Patrick J van der GeestA B Johan Groeneveld
Apr 23, 2017·Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy·Yuichi ShibataHiroshige Mikamo
Aug 12, 2017·Clinics in Chest Medicine·Eva M Carmona, Andrew H Limper