Hepatotoxicity Risk Associated With Anidulafungin, Caspofungin, and Micafungin

Abnormal Liver Microscopic
Abnormal Liver Microscopic
Anidulafungin, caspofungin, and micafungin have shown similar risk profiles for severe hepatotoxicity.

Anidulafungin, caspofungin, and micafungin have shown similar risk profiles for severe hepatotoxicity, according to a study recently published in BMC Infectious Diseases. However, anidulafungin is a better choice for patients who are sicker or who have a poorer prognosis and comorbidities.

This retrospective cohort study included the records of 1700 individuals treated with anidulafungin, 4431 treated with caspofungin, and 6547 treated with micafungin. Researchers defined severe hepatotoxicity as a liver function test grade greater than or equal to 3 pre-echinocandin initiations, of which the percentages were 40.4% for anidulafungin, 25.9% for caspofungin (P <.001), and 25.6% for micafungin (P <.001). Critical care admissions had been experienced by 75.3%, 52.6%, and 48.6% of the cohort, respectively, while organ failures occurred in 69.4%, 46.7%, and 51.5% of participants using anidulafungin, caspofungin, and micafungin, respectively. 

Severe hepatotoxicity among those using anidulafungin compared with caspofungin and micafungin showed adjusted incidence rate ratios of 1.43 (P =.002) and 1.19 (P =.183), respectively. In terms of normal baseline liver function test, the respective figures for those using anidulafungin compared with caspofungin and micafungin were .88 (P=.773) and .97 (P =.945).

Data for this study were collected from electronic databases of medical records in 2 hospitals in the United States. Inclusion criteria included age >18 years, one administered dose of only one of the 3 study drugs while hospitalized, and at least 1 liver function test to measure plasma during both baseline and observation periods.

The study researchers concluded that “the risk of severe hepatotoxicity was not statistically significantly different between patients treated with anidulafungin and those treated with caspofungin or micafungin. There is a clear evidence of favoring the use of anidulafungin treatment in sicker patients with worse prognosis and comorbidities. The confounding by indication bias may not have been fully adjusted for in the analysis.”

Related Articles

This study was funded by Pfizer. For a full list of funding and author disclosures, visit the reference.


Vekeman F, Weiss L, Aram J, et al. Retrospective cohort study comparing the risk of severe hepatotoxicity in hospitalized patients treated with echinocandins for invasive candidiasis in the presence of confounding by indicationBMC Infect Dis. 2018;18(1):438. doi: 10.1186/s12879-018-3333-0