Equinocandinas / Echinocandins

ABSTRACT

The echinocandins, caspofugin, micafungin, and anidulafungin, are lipopeptides that inhibit fungal growth by binding to β - (1.3) d glucan synthase. This enzyme is responsible for the formation of the peptidoglycan cell wall, and it is essential in fungi such as Candida spp, but less important in the case of Aspergillus and Fusarium species. We review the history, pharmacology and clinical trials that have showed clinical efficacy similar to amphotericin B for the management of fungal infections such as candidemia, invasive candidiasis and aspergillosis, even in cases refractory to initial treatment. These drugs have less toxicity and discontinuation is uncommonly required. Despite similar spectrum and tolerability, there are several pharmacological differences. Only a few clinical trials compare the clinical efficacy between them and their clinical application cannot be generalized. However, the echinocandins have demonstrated clinical efficacy in patients with invasive candidiasis and in others forms of systemic mycoses.

RESUMEN

Las equinocandinas -caspofugina, micafungina y ani-dulafungina- son lipopéptidos que inhiben el crecimiento fúngico al unirse a la β-(1,3) d glucano sintetasa, enzima esencial para la síntesis en la pared celular de hongos como Candida spp, y menos importante en el caso de especies de Aspergillus y Fusarium. Se revisa la historia, farmacología y los diferentes ensayos clínicos que han evidenciado similar eficacia clínica a la de anfotericina B para el manejo de infecciones micóticas como candidemia, candidiasis invasora y aspergilosis, inclusive en casos refractarios al manejo inicial. Estos medicamentos tienen menor toxicidad y en pocos casos hay necesidad de retiro del tratamiento. Dado su espectro y tolerabilidad similar, su farmacología permite diferenciarlas. Se dispone de información limitada de estudios clínicos que las comparen entre ellas, limitando la extrapolación de la información a todo el grupo. Sin embargo, presentan eficacia clínica comprobada en pacientes con varias micosis invasoras.