The WHO has added the antifungal drugs Echinocandins to the 2021 Essential Medicines List for low and middle countries, for both adults and children after the Global Action Fund for Fungal Infections (GAFFI) made an application to the WHO on behalf of many countries without access to these life-saving antifungal medicines.
Echinocandin antifungal drugs are the ‘workhorses’ of antifungal therapy in hospitals. Initially launched in 2002 in Japan and USA, micafungin (Astellas) and caspofungin (Merck) were the first to market and then in 2006, anidulafungin (Pfizer) was also approved for use. The echinocandins kill almost all species of Candida and have good activity against Aspergillus, the commonest life-threatening fungi. The echinocandins are only effective if given intravenously.

Professor David Denning, of University of Manchester and Scientific Advisor to the Fungal Infection Trust, said:

“This is good news for patients across the world. Although most countries have at least one echinocandin approved for use, prices are often high. Also, the multi-drug resistant hospital fungus Candida auris is difficult to treat without echinocandins.”

Micafungin is recommended ahead of caspofungin and anidulafungin, because of its current country availability and more published data for chronic pulmonary aspergillosis and premature infants.

GAFFI recommends that the echinocandin class is considered essential therapy for:

• Invasive candidiasis in adults and children
• Invasive candidiasis and candidaemia in neonates (micafungin only)
• Oesophageal candidiasis in patients unresponsive to azoles
• Invasive and chronic pulmonary aspergillosis in patients refractory to azole therapy, intolerant to azoles and in those with azole resistant infections
• As prophylaxis in neutropenic patients in whom azoles are contra-indicated.

Link to:

GAFFI’s application to the WHO: