Eraxis (Anidulafungin) - Side Effects and Adverse Reactions

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The safety of ERAXIS for Injection was assessed in 929 individuals, including 257 healthy subjects and 672 patients in clinical trials of candidemia, other forms of Candida infections, and esophageal candidiasis. A total of 633 patients received ERAXIS at daily doses of either 50 mg or 100 mg. A total of 481 patients received ERAXIS for ≥14 days.

Candidemia/other Candida Infections

Three studies (one comparative vs. fluconazole, two non-comparative) assessed the efficacy and safety of ERAXIS (100 mg) in patients with candidemia and other Candida infections.

The data described below reflect exposure to ERAXIS and fluconazole in 127 and 118 patients, respectively, with candidemia and other forms of invasive candidiasis, in the randomized, comparative trial of the efficacy and safety of ERAXIS to that of fluconazole. In ERAXIS-treated patients, the age range was 16–89 years, the gender distribution was 51% male and 49% female, and the race distribution was 72% White, 18% Black/African American, 9% other races. Patients were randomized to receive once daily IV ERAXIS (200 mg loading dose followed by 100 mg maintenance dose) or IV fluconazole (800 mg loading dose followed by 400 mg maintenance dose). Treatment was administered for at least 14 and not more than 42 days.

The number of patients with adverse reactions leading to discontinuation of study medication was 11.5% in the ERAXIS arm and 21.6% in the fluconazole arm. The most common adverse reactions leading to study drug discontinuation were multi-organ failure and systemic Candida infection in the ERAXIS arm.

Table 2 presents adverse reactions that were reported in ≥5% of subjects receiving ERAXIS or fluconazole therapy in this trial.

Table 2: Adverse Reactions Reported in ≥5% of Subjects Receiving ERAXIS or Fluconazole Therapy for Candidemia/other Candida InfectionsA patient who experienced multiple reactions with a System Organ Class (SOC) or preferred term was counted one time for that class, one time for the preferred term and one time for "subjects with at least one adverse reaction" ^, This trial was not designed to support comparative claims for ERAXIS for the adverse reactions reported in this table.

	ERAXIS 100 mg N=131	Fluconazole 400 mg N=125
	N (%)	N (%)
Subjects with a least one adverse reaction	130 (99)	122 (98)
Infections and infestations	82 (63)	80 (64)
Bacteremia	23 (18)	23 (18)
Urinary tract infection	19 (15)	22 (18)
Sepsis	9 (7)	11 (9)
Pneumonia	8 (6)	19 (15)
Gastrointestinal disorders	81 (62)	72 (58)
Nausea	32 (24)	15 (12)
Diarrhea	24 (18)	23 (18)
Vomiting	23 (18)	12 (10)
Constipation	11 (8)	14 (11)
Abdominal pain	8 (6)	16 (13)
General disorders and administration site conditions	70 (53)	76 (61)
Pyrexia	23 (18)	23 (18)
Edema peripheral	14 (11)	16 (13)
Chest pain	7 (5)	6 (5)
Respiratory, thoracic, and mediastinal disorders	67 (51)	55 (44)
Dyspnea	15 (12)	4 (3)
Pleural effusion	13 (10)	11 (9)
Cough	9 (7)	7 (6)
Respiratory distress	8 (6)	2 (2)
Investigations	66 (50)	46 (37)
Blood alkaline phosphatase increased	15 (12)	14 (11)
White blood cell increased	11 (8)	3 (2)
Hepatic enzyme increased	7 (5)	14 (11)
Blood creatinine increased	7 (5)	1 (1)
Metabolism and nutrition disorders	61 (47)	61 (49)
Hypokalemia	33 (25)	24 (19)
Hypomagnesemia	15 (12)	14 (11)
Hypoglycemia	9 (7)	10 (8)
Hyperkalemia	8 (6)	14 (11)
Hyperglycemia	8 (6)	8 (6)
Dehydration	8 (6)	2 (2)
Vascular disorders	50 (38)	41 (33)
Hypotension	19 (15)	18 (14)
Hypertension	15 (12)	5 (4)
Deep vein thrombosis	13 (10)	9 (7)
Psychiatric disorders	48(37)	45 (36)
Insomnia	20 (15)	12 (10)
Confusional state	10 (8)	10 (8)
Depression	8 (6)	5 (4)
Blood and lymphatic system disorders	34 (26)	36 (29)
Anemia	12 (9)	20 (16)
Thrombocythemia	8 (6)	1 (1)
Leukocytosis	7 (5)	6 (5)
Skin and subcutaneous tissue disorders	30 (23)	32 (26)
Decubitus ulcer	7 (5)	10 (8)
Nervous system disorders	27 (21)	31 (25)
Headache	11 (8)	10 (8)
Musculoskeletal and connective tissue disorders	27 (21)	25 (20)
Back pain	7 (5)	13 (10)

Esophageal Candidiasis

The data described below reflect exposure to ERAXIS and fluconazole in 300 and 301 patients, respectively, with esophageal candidiasis in a randomized trial comparing the efficacy and safety of ERAXIS to that of oral fluconazole. In ERAXIS-treated patients, the age range was 18–68 years, the gender distribution was 42% male and 58% female and the race distribution was 15% White, 49% Black/African American, 15% Asian, 0.3 % Hispanic, 21% other races. Patients were randomized to receive IV ERAXIS (100 mg on day 1, followed by 50 mg per day) or oral fluconazole (200 mg on day 1, followed by 100 mg per day) for 7 days beyond resolution of symptoms (range, 14–21 days).

Twenty eight (9%) patients in the ERAXIS arm and 36 (12%) patients in the fluconazole arm had adverse reactions leading to discontinuation of study medication. The most common adverse reactions leading to study drug discontinuation were maculopapular rash for the ERAXIS arm. The most common adverse reactions leading to discontinuation were rash and increased AST for the fluconazole arm.

Table 3 presents adverse reactions that were reported in ≥5% of subjects receiving ERAXIS therapy.

Table 3 Adverse Reactions Reported in ≥5% of Subjects Receiving ERAXIS or Fluconazole Therapy for Esophageal CandidiasisA patient who experienced multiple reactions with a System Organ Class (SOC) or preferred term was counted one time for that class, one time for the preferred term and one time for "subjects with at least one adverse reaction" ^, This trial was not designed to support comparative claims for ERAXIS for the adverse reactions reported in this table.

	ERAXIS 50 mg N=300	Fluconazole 100 mg N=301
	N (%)	N (%)
Subjects with a least one adverse reactions	239 (80)	227 (75)
Infections and infestations	115 (38)	99 (33)
Oral candidiasis	15 (5)	10 (3)
Gastrointestinal disorders	106 (35)	113 (38)
Diarrhea	27(9)	26(9)
Vomiting	27(7)	30(10)
Nausea	20(7)	23(8)
Dyspepsia	20(7)	21(7)
Blood and lymphatic system disorders	55 (18)	50 (17)
Anemia	25 (8)	22 (7)
Metabolism and nutrition disorders	50 (17)	46 (15)
Hypokalemia	14 (5)	17 (6)
General disorders and administration site condition	49 (16)	54 (18)
Pyrexia	27(9)	28(9)
Nervous system disorders	39 (13)	36 (12)
Headache	25 (8)	20 (7)

Less Common Adverse Reactions

The following selected adverse reactions occurred in <2% of patients:

Blood and Lymphatic: coagulopathy, thrombocytopenia

Cardiac: atrial fibrillation, bundle branch block (right), sinus arrhythmia, ventricular extrasystoles

Eye: eye pain, vision blurred, visual disturbance

General and Administration Site: infusion related reaction, peripheral edema, rigors

Hepatobiliary: abnormal liver function tests, cholestasis, hepatic necrosis

Infections: clostridial infection

Investigations: amylase increased, bilirubin increased, CPK increased, electrocardiogram QT prolonged, gamma-glutamyl transferase increased, lipase increased, potassium decreased, prothrombin time prolonged, urea increased

Nervous System: convulsion, dizziness

Respiratory, Thoracic and Mediastinal: cough

Skin and Subcutaneous Tissue: angioneurotic edema, erythema, pruritus, sweating increased, urticaria

Vascular: flushing, hot flushes, thrombophlebitis superficial

Post-marketing Experience

The following adverse reactions have been identified during post approval use of anidulafungin. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Immune: Anaphylactic shock, anaphylactic reaction, bronchospasm [see Warnings and Precautions ].