do not use membranes derived from polyacrylonitrile
LIntensive care anesthetists have been instructed not to use membranes derived from polyacrylonitrile in intensive care patients undergoing hemofiltration and receiving caspofungin treatment. [1] (cf. Boxed).
The National Agency for the Safety of Medicines and Health Products (ANSM) and Sfar (French Society of Anesthesia and Resuscitation) recommend:
- to use another extra-renal purification membrane in patients in intensive care undergoing hemofiltration and receiving treatment with caspofungin,
- or consider another antifungal medication if the yeast is sensitive to it, according to current recommendations [2].
| Caspofungin is a semi-synthetic lipopeptide (echinocandin). This injectable antifungal is indicated in the treatment of invasive candidiasis and invasive aspergillosis. |
Ineffectiveness of caspofungin and serious consequences
According to available data, the polyacrylonitrile filter reduces the effectiveness of caspofungin, resulting in a risk of worsening of the fungal infection:
- sequestration of caspofungin by the polyacrylonitrile filter: the preliminary results of an experimental study published in the International Journal of antimicrobial agents [3] indeed suggest significant sequestration of echinocandins (including caspofungin) in a polyacrylonitrile filter. According to this same study, increasing the dose of antifungal does not reduce this phenomenon of sequestration in the filter;
- pharmacovigilance reports: ANSM reports several reports of suspected ineffectiveness of caspofungin used in these conditions for a candida infection, including 4 deaths.
