ERAXIS SIDE EFFECTS
- Generic Name: anidulafungin
- Brand Name: Eraxis
SIDE EFFECTS
The following most serious adverse reactions are described elsewhere in other labeling sections:
- Hepatic Adverse Reactions.
- Anaphylactic and Hypersensitivity 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.
Clinical Trials Experience In Adults
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 trials (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 (2.3%) and systemic Candida infection (1.5%) 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 1: Adverse Reactions Reported in ≥5% of Adult Patients Receiving ERAXIS or Fluconazole Therapy for Candidemia/other Candida Infections*, **
| Adverse Reaction | ERAXIS 100 mg N=131 |
Fluconazole 400 mg N=125 |
| N (%) | N (%) | |
| Subjects with a least one adverse reaction | 130 (99) | 122 (98) |
| 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) |
| *A patient who experienced multiple reactions within a Body System 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. |
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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 related to study medication. The most common adverse reactions leading to study discontinuation were maculopapular rash (1 patient) for the ERAXIS arm. The most common adverse reactions leading to discontinuation were rash (1 patient) and increased AST (1 patient) for the fluconazole arm.
Table 2 presents adverse reactions that were reported in ≥5% of subjects receiving ERAXIS therapy.
Table 2: Adverse Reactions Reported in ≥5% of Adult Patients Receiving ERAXIS or Fluconazole Therapy for Esophageal Candidiasis*, **
| Adverse Reaction | ERAXIS 50 mg N=300 |
Fluconazole 100 mg N=301 |
| N (%) | N (%) | |
| Subjects with a least one adverse reaction | 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) |
| *A patient who experienced multiple reactions within a Body System 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. |
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Less Common Adverse Reactions in Adult Patients with Candidemia/other Candida Infections and Esophageal Candidiasis
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
Clinical Trials Experience In Pediatric Patients With Candidemia/Invasive Candidiasis
The safety of ERAXIS was investigated in 68 pediatric patients from 1 month to less than 18 years of age with candidemia/invasive candidiasis in a prospective, open-label, non-comparative pediatric trial [see Clinical Studies]. Overall, the safety profile of ERAXIS in the pediatric patients 1 month and older was similar to that of adults.
Most Common Adverse Reactions
The most common adverse reactions occurring in ≥5% of pediatric patients receiving ERAXIS therapy in the clinical trial are displayed by body system in Table 4.
Table 3 Adverse Reactions Occurring in ≥5% of Pediatric Patients Receiving ERAXIS Therapy for Candidemia/other Candida Infections*,**
| Adverse Reaction | 1 month to <2 years N=19 |
2 to <5 years N=19 |
5 to <18 years N=30 |
Overall N=68 |
| n (%) | n (%) | n (%) | n (%) | |
| Subjects with a least one adverse reaction | 17 (90) | 14 (74) | 24 (80) | 55 (81) |
| Blood and lymphatic system disorders | 9 (47) | 3 (16) | 4 (13) | 16 (24) |
| Anemia | 5 (26) | 2 (11) | 0 | 7 (10) |
| Thrombocytopenia | 2 (11) | 1 (5) | 1 (3) | 4 (6) |
| Gastrointestinal disorders | 8 (42) | 8 (42) | 12 (40) | 28 (41) |
| Diarrhea | 4 (21) | 2 (11) | 5 (17) | 11 (16) |
| Vomiting | 4 (21) | 5 (26) | 2 (7) | 11 (16) |
| Abdominal paina | 0 | 4 (21) | 2 (7) | 6 (9) |
| General disorders and administration site condition | 5 (26) | 6 (32) | 9 (30) | 20 (29) |
| Pyrexia | 4 (21) | 3 (16) | 5 (17) | 12 (18) |
| Laboratory Investigations | 4 (21) | 4 (21) | 8 (27) | 16 (24) |
| Alanine aminotransferase increased | 2 (11) | 2 (11) | 2 (7) | 6 (9) |
| Aspartate aminotransferase increased | 2 (11) | 1 (5) | 1 (3) | 4 (6) |
| Metabolism and nutrition disorders | 3 (16) | 4 (21) | 6 (20) | 13 (19) |
| Hypoglycemia | 1 (5) | 2 (11) | 1 (3) | 4 (6) |
| Respiratory, thoracic and mediastinal disorders | 5 (26) | 5 (26) | 5 (17) | 15 (22) |
| Epistaxis | 1 (5) | 2 (11) | 3 (10) | 6 (9) |
| Skin and subcutaneous tissue disorders | 6 (32) | 5 (26) | 5 (17) | 16 (24) |
| Rashb | 3 (16) | 1 (5) | 2 (7) | 6 (9) |
| * Reflects adverse reactions including those that started on or after first dose of anidulafungin through 6-week follow-up for patients who did not receive oral fluconazole, and those that started between first dose and last dose of anidulafungin for patients who received oral fluconazole. ** A patient who experienced multiple reactions within a Body System 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”. a Includes such terms as: abdominal pain and abdominal pain upper. b Includes such terms as: rash and rash generalized. |
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Other adverse reactions were reported in 2 or more pediatric patients and in less than 5% of the 68 pediatric patients treated with ERAXIS in the clinical trial:
Blood and Lymphatic System Disorders: pancytopenia, thrombocytosis, febrile neutropenia, leukopenia, neutropenia
Eye Disorders: Periorbital edema
Gastrointestinal Disorders: gastroesophageal reflux disease, abdominal distension, nausea, stomatitis, dry mouth
General Disorders and Administrative Site Conditions: chest pain, edema peripheral
Infections and Infestations: bacteremia, device related infection, gastroenteritis, lower respiratory tract infection, upper respiratory tract infection, urinary tract infection
Laboratory Investigations: gamma-glutamyltransferase increased, transaminases increased
Metabolism and Nutrition Disorders: hypocalcemia, hypokalemia, hyponatremia, hypoproteinemia
Musculoskeletal and Connective Tissue Disorders: back pain, pain in extremity
Nervous System Disorders: headache, tremor, seizure
Psychiatric Disorders: agitation
Respiratory, Thoracic and Mediastinal Disorders: hemoptysis
Vascular Disorders: hypotension
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.
SRC: NLM .