Каспофунгин: противогрибковый препарат для лечения инвазивных инфекций.

Antifungal medication

1 [(4R,5S) 5 [(2 Aminoethyl)amino] N2 (10,12 dimethyl 1 oxotetradecyl) 4 hydroxy L ornithine] 5 [(3R) 3 hydroxy L ornithine] pneumocandin B0 brand name Cancidas) is a lipopeptide antifungal drug from Merck & Co., Inc It is a member of a class of antifungals termed the echinocandins. It works by inhibiting the enzyme (1→3) β D glucan synthase and thereby disturbing the integrity of the fungal cell wall. Caspofungin was the first inhibitor of fungal (1→3) β D glucan synthesis to be approved by the United States Food and Drug Administration. Caspofungin is administered intravenously.

Caspofungin acetate for injection was initially approved by both the US Food and Drug Administration (FDA), and the European Medicines Agency (EMA) in 2001. Its approved therapeutic indications by both organizations include the empirical therapy of presumed fungal infections in febrile, neutropenic adults and for salvage therapy in people treatment of invasive aspergillosis in adults whose disease is refractory to, or who are intolerant of, other antifungal agents (i. e., conventional or lipid formulations of amphotericin B and/or itraconazole). Additionally, the FDA approval includes indication for the treatment of candidemia and some specific Candida infections (intra abdominal abscesses, peritonitis, pleural cavity infections, and esophagitis) and the EMA approval includes indication for the treatment of general invasive candidiasis in adults. The mean duration of therapy in previous studies was 34 days. Some people were even healed by a one day treatment. However, a few people were treated for as long as 162 days and tolerated the drug well, indicating that longtime use may be indicated and tolerated favourably in complicated cases of aspergillosis. Generally, the duration of treatment is dictated by the severity of the disease, the clinical response, and the improvement of immunocompetence in immunocompromised peopls. About 36% of patients refractory to other therapies responded well to caspofungin therapy, while even 70% of patients intolerant to other therapies were classified as responders. Direct comparative studies to other drugs in the treatment of invasive aspergillosis have so far not been undertaken.

Caspofungin has been shown in animal studies to have embryotoxic properties. The drug is found in the milk of lactating rats, but it is not known whether this is seen in humans. Caspofungin is FDA approved for people aged three months and older.

The concomitant use of caspofungin and ciclosporin in healthy volunteers led to a more frequent increase of liver enzymes (ALT=SGPT and AST=SGOT) than noted with cyclosporine alone.

Reactions due to histamine release (rash, facial swelling, pruritus, sensation of warmth) have been seen. Known hypersensitivity to caspofungin acetate or any other ingredient contained in the formulation contraindicate its use.

Caspofungin is semisynthesized from pneumocandin B0, a fermentation product of Glarea lozoyensis.

Caspofungin is slowly metabolized by peptide hydrolysis and N acetylation in liver. Therefore, in case of liver impairment the dose needs to be reduced. Caspofungin also undergoes spontaneous chemical degradation to an open ring peptide compound, L 747969. Additional metabolism involves hydrolysis into constitutive amino acids and their derivatives, including dihydroxyhomotyrosine and N acetyl dihydroxyhomotyrosine.