Randomized, double-blind trial of Anidulafungin versus Fluconazole for prophylaxis of invasive fungal infections in high-risk liver transplant recipients.
Winston DJ, Limaye AP, Pelletier S, et al.American journal of transplantation 2014;14:2758
Aims
To compare anidulafungin versus fluconazole for antifungal prophylaxis of invasive fungal infections (IFI) in high risk liver transplant recipients.
Interventions
Participants were administered with anidulafungin (200mg intravenous loading dose followed by 100mg intravenous daily) or fluconazole (400mg intravenously daily) for 21 days or until discharged (up to 42 days).
Participants
200 adult liver transplant recipients with a high risk of developing IFI.
Outcomes
The primary outcome was the incidence of proven or probable IFIs within 90 days of transplantation. Secondary outcomes were fungal-free survival, fungal colonization, rejection, graft loss, and all cause mortality.
Follow-up
Up to 90 days.
CET Conclusions
This manuscript reports a good quality, double blind trial comparing the echinocandin Anidulafungin to fluconazole for prophylaxis in high-risk liver transplant recipients. There is a low rate of invasive fungal infections in both arms, with no significant differences seen. There were numerically fewer aspergillus and resistant infections in the Anidulafungin arm, but the small numbers meant that none of these differences reached statistical significance. This is a much needed trial – our own recent network meta-analysis on the topic suggested that fluconazole and amphotericin B are equally effective methods for prophylaxis, but identified a lack of evidence for newer agents such as the echinocandins (Am J Transplant 2014; 14(12): 2765). As the agents are comparable in efficacy, cost should be a consideration, which is not mentioned anywhere in this manuscript.
Data analysis
Modified intention-to-treat analysis
Trial registration
ClinicalTrials.gov – NCT00841971