What is the antimicrobial coverage of caspofungin (Cancidas)?

From the Guidelines

Caspofungin is an effective antifungal agent that primarily covers Candida species and Aspergillus species, and is recommended as initial therapy for most adult patients with candidemia, especially those with moderately severe to severe illness or recent azole exposure, at a loading dose of 70 mg, then 50 mg daily 1.

Key Points

• Caspofungin is effective against most Candida species, including C. albicans, C. glabrata, C. tropicalis, and C. krusei, including fluconazole-resistant strains.
• It also shows good activity against Aspergillus species such as A. fumigatus, A. flavus, and A. terreus.
• However, it has limited or no activity against Cryptococcus neoformans, Fusarium species, Scedosporium species, Zygomycetes (Mucorales), and endemic fungi like Histoplasma or Blastomyces.
• The standard adult dosing is a 70mg loading dose followed by 50mg daily, with dose reduction to 35mg daily for moderate hepatic insufficiency.
• Caspofungin works by inhibiting the synthesis of beta-(1,3)-D-glucan, an essential component of the fungal cell wall, leading to osmotic instability and cell death.
• It is generally well-tolerated with fewer drug interactions compared to azole antifungals, though it can cause infusion-related reactions, elevated liver enzymes, and occasionally rash or fever.
• Caspofungin requires intravenous administration and is often used for invasive candidiasis, candidemia, and as salvage therapy for invasive aspergillosis, as recommended by the Infectious Diseases Society of America 1.

Clinical Use

• Caspofungin is recommended as initial therapy for most adult patients with candidemia, especially those with moderately severe to severe illness or recent azole exposure.
• It is also recommended for patients with invasive candidiasis, including those with candidemia, and for salvage therapy for invasive aspergillosis.
• The recommended duration of therapy for candidemia without obvious metastatic complications is for 2 weeks after documented clearance of Candida species from the bloodstream and resolution of symptoms attributable to candidemia 1.

From the FDA Drug Label

Caspofungin has been shown to be active against most strains of the following microorganisms both in vitro and in clinical infections: Aspergillus flavus Aspergillus fumigatus Aspergillus terreus Candida albicans Candida glabrata Candida guilliermondii Candida krusei Candida parapsilosis Candida tropicalis

Caspofungin coverage includes:

• Aspergillus species: Aspergillus flavus, Aspergillus fumigatus, Aspergillus terreus
• Candida species: Candida albicans, Candida glabrata, Candida guilliermondii, Candida krusei, Candida parapsilosis, Candida tropicalis 2

From the Research

Caspofungin Coverage

• Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA) 3, 4, 5, 6, 7
• The drug has been shown to be effective in treating IC, with a favorable response rate of 77% in one study 3
• Caspofungin has also been found to be effective in treating IA, with a favorable response rate of 79% in one study 3 and 45% in another study 6
• The drug has been approved for the treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies 4, 5, 6, 7
• Caspofungin has been found to be generally well tolerated, with few adverse events reported 3, 4, 5, 6, 7

Spectrum of Activity

• Caspofungin has broad-spectrum antifungal activity against Candida and Aspergillus spp. 4, 7
• The drug has been shown to be effective against various species of Candida, including Candida albicans and non-albicans species 3, 7
• Caspofungin has also been found to be effective against various species of Aspergillus, including Aspergillus fumigatus 4, 6

Clinical Use

• Caspofungin can be used as first-line therapy for invasive candidiasis and invasive aspergillosis 3, 5
• The drug can also be used as salvage therapy for patients who are refractory to or intolerant of other antifungal therapies 4, 6, 7
• Caspofungin has been found to be effective in patients with severe hematological disorders, including those with acute myeloid leukemia and allogeneic stem cell transplant recipients 3