Echinocandins

Does Echinocandins work?

Yes, in large controlled trials of 224 and 245 patients.

Each echinocandin was approved on randomized, double-blind trials against an established antifungal. The two cited here are caspofungin versus amphotericin B in 224 patients with invasive candidiasis and anidulafungin versus fluconazole in 245 patients with invasive candidiasis, 89% of them candidemia only. Rezafungin was approved in 2023 on a noninferiority trial against caspofungin. ¹²³

The 2002 trial that established the class randomized 224 adults with invasive candidiasis. They got caspofungin or conventional amphotericin B. Success rates were similar: 73% against 62% in the modified intention-to-treat analysis. Caspofungin did at least as well as the older drug. Death rates did not differ. Amphotericin B caused far more drug-related side effects, including kidney injury and infusion reactions. More patients stopped it. ¹

In 2007, researchers compared anidulafungin with fluconazole in 245 patients with candidemia or invasive candidiasis. Treatment worked in 76% of anidulafungin patients and 60% of fluconazole patients. That gap was significant, so the drug looked better. The analysis found no center effect. But when the largest-enrolling site was removed, the rates were 73% and 61%, and the gap was no longer significant. The trial itself concluded only that the drug did at least as well. So the finding reads as 'at least as good as fluconazole, possibly better'. ²

Read the full Echinocandins page

Reference information only, not medical advice. Drawn from the Echinocandins article, fact-checked against the cited sources. No dosing anywhere on this site.