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Evaluation of an early step-down strategy from intravenous anidulafungin to oral azole therapy for the treatment of candidemia and other forms of invasive candidiasis: results from an open-label trial

Jose Vazquez1, Annette C Reboli2, Peter G Pappas3, Thomas F Patterson4, John Reinhardt5, Peter Chin-Hong6, Ellis Tobin7, Daniel H Kett8, Pinaki Biswas9 and Robert Swanson9*

Author Affiliations

1 Georgia Regents University, Augusta, GA, USA

2 Cooper Medical School of Rowan University, Camden, NJ, USA

3 University of Alabama at Birmingham, Birmingham, AL, USA

4 University of Texas and South Texas Veterans Health Care System, San Antonio, TX, USA

5 Christiana Care Health Services, Newark, DE, USA

6 University of California San Francisco, San Francisco, CA, USA

7 Albany Medical Center, Albany, NY, USA

8 University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL, USA

9 Pfizer Inc, New York, NY, USA

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BMC Infectious Diseases 2014, 14:97  doi:10.1186/1471-2334-14-97

Published: 21 February 2014



Hospitalized patients are at increased risk for candidemia and invasive candidiasis (C/IC). Improved therapeutic regimens with enhanced clinical and pharmacoeconomic outcomes utilizing existing antifungal agents are still needed.


An open-label, non-comparative study evaluated an intravenous (IV) to oral step-down strategy. Patients with C/IC were treated with IV anidulafungin and after 5 days of IV therapy had the option to step-down to oral azole therapy (fluconazole or voriconazole) if they met prespecified criteria. The primary endpoint was the global response rate (clinical + microbiological) at end of treatment (EOT) in the modified intent-to-treat (MITT) population (at least one dose of anidulafungin plus positive Candida within 96 hours of study entry). Secondary endpoints included efficacy at other time points and in predefined patient subpopulations. Patients who stepped down early (≤ 7 days’ anidulafungin) were identified as the "early switch" subpopulation.


In total, 282 patients were enrolled, of whom 250 were included in the MITT population. The MITT global response rate at EOT was 83.7% (95% confidence interval, 78.7–88.8). Global response rates at all time points were generally similar in the early switch subpopulation compared with the MITT population. Global response rates were also similar across multiple Candida species, including C. albicans, C. glabrata, and C. parapsilosis. The most common treatment-related adverse events were nausea and vomiting (four patients each).


A short course of IV anidulafungin, followed by early step-down to oral azole therapy, is an effective and well-tolerated approach for the treatment of C/IC.

Trial registration NCT00496197

Anidulafungin; Azole; Candidemia; Step-down strategy