Caspofungin versus anidulafungin in patients with invasive candidiasis: a retrospective study with propensity-score-matched analysis

<h3>Background</h3><p dir="ltr">Echinocandins are recommended as an initial treatment for invasive candidiasis. Although safety and efficacy profiles of both anidulafungin and caspofungin are well established, direct head-to-head comparisons have not been reported before.</p><h3>Objective</h3><p dir="ltr">Compare efficacy and safety of anidulafungin versus caspofungin among patients with invasive candidiasis.</p><h3>Design</h3><p dir="ltr">Retrospective observational study.</p><h3>Methods</h3><p dir="ltr">Adult patients with invasive candidiasis who were treated with either anidulafungin or caspofungin for ⩾5 days were retrospectively reviewed over a period of 6 years. The primary endpoint was global response, defined as clinical and microbiological success at the end of treatment duration.</p><h3>Results</h3><p dir="ltr">A total of 223 patients who received either anidulafungin ( <i>n</i> = 176) or caspofungin ( <i>n</i> = 47) were initially included. Propensity score matching (based on age, malignancy, level of care, presence of candidemia, and other factors) was performed to improve comparability of the two groups. As a result, 32 patients in the caspofungin arm and 79 patients in the anidulafungin arm were included in the final analysis. Around three-quarters of the cohort had candidemia, and the most common isolated <i>Candida</i> species were <i>C. albicans </i>and <i>C. glabrata</i> . Response rates were comparable between both groups, with the primary outcome of global response showing no significant difference (56.3% for the caspofungin group vs 63.3% for anidulafungin,<i> p</i> = 0.490). Similarly, no differences between the two groups were observed in terms of 90-day all-cause mortality ( p = 0.672) or any other secondary endpoints.</p><h3>Conclusion</h3><p dir="ltr">Our data suggest that anidulafungin and caspofungin have comparable global response among patients with invasive candidiasis. Additionally, both studied echinocandins showed no significant difference in 90-day all-cause mortality. However, due to the limited sample size, larger studies are needed to confirm these results.</p><h2>Other Information</h2><p dir="ltr">Published in: Therapeutic Advances in Infectious Disease<br>License: <a href="https://creativecommons.org/licenses/by/4.0/" target="_blank">https://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1177/20499361251344777" target="_blank">https://dx.doi.org/10.1177/20499361251344777</a></p>