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. 2022 Jul;82(11):1193-1205.
doi: 10.1007/s40265-022-01751-x. Epub 2022 Aug 12.

Global Consumption Trend of Antifungal Agents in Humans From 2008 to 2018: Data From 65 Middle- and High-Income Countries

Swathi Pathadka #  1   2 , Vincent K C Yan #  1 , Chin Fen Neoh  3   4   5   6 , Daoud Al-Badriyeh  7 , David C M Kong  8   9   10 , Monica A Slavin  3   4   11 , Benjamin J Cowling  12 , Ivan F N Hung  13 , Ian C K Wong  1   14   15   16 , Esther W Chan  17   18   19   20
Affiliations

Global Consumption Trend of Antifungal Agents in Humans From 2008 to 2018: Data From 65 Middle- and High-Income Countries

Swathi Pathadka et al. Drugs. 2022 Jul.

Abstract

Background: Understanding the trend of global antifungal agent consumption could assist with identification of global healthcare policy inadequacies and promote accessibility and availability of antifungal agents.

Methods: Using pharmaceutical sales data from the IQVIA-multinational integrated data analysis system database, we assessed use of systemic antifungal agents in humans in 27 middle- and 38 high-income countries from 2008 through 2018.

Results: Consumption of systemic antifungal agents increased from 0.50 (in 2008) to 0.92 defined daily dose (DDD)/1000 inhabitants/day (in 2018), with a compound annual growth rate of 6.2%. High-income countries remain major consumers of antifungal agents with large variance in quantities consumed, with a gradual decline in consumption in recent years. Consumption in middle-income countries increased. Itraconazole (0.32 DDD/1000 inhabitants/day), terbinafine (0.30 DDD/1000 inhabitants/day), and fluconazole (0.23 DDD/1000 inhabitants/day) were the most commonly used antifungal agents in middle- and high-income countries in 2018. Following incorporation into the World Health Organization Essential Medicines List, itraconazole consumption in middle-income countries surged. Consumption of ketoconazole slowly declined, with 5.04% annual decrease, probably due to labelling changes in 2013 to reflect hepatotoxicity concerns. The use of polyenes (0.004 DDD/1000 inhabitants/day) and echinocandins (0.003 DDD/1000 inhabitants/day) were lowest among all the antifungal drug classes.

Conclusion: Global consumption of triazoles and terbinafine has gradually increased in middle- and high-income countries. Life-saving antifungal agents, including echinocandins and polyenes, are available only parenterally and may be underutilized, mainly in middle-income countries. Future research on country-specific epidemiology is warranted to guide health policy coordination to ensure equitable access to appropriate use of antifungal agents.

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Conflict of interest statement

EWC has received research grants from the Research Grants Council (RGC, Hong Kong), Narcotics Division of the Security Bureau of the Government of the Hong Kong SAR, Research Fund Secretariat of the Food and Health Bureau, National Natural Science Fund of China, Wellcome Trust, Bayer, Bristol-Myers Squibb, Pfizer, Janssen, Amgen, and Takeda, outside the submitted work. ICKW has received research grants from Research Grants Council (RGC, Hong Kong), Innovative Medicines Initiative (IMI), Shire, Janssen-Cilag, Eli-Lily, Pfizer, Bayer, and grants from European Union FP7 program, outside the submitted work. DCMK has sat on advisory boards for Becton Dickinson Pty Ltd and Merck Sharp & Dohme (MSD), and received financial support from MSD and F2G, outside the submitted work. MS has received grants from Gilead Sciences, Merck, F2G, and Pfizer unrelated to the submitted work. BJC has received funding from Sanofi Pasteur and Roche, outside the submitted work. The other author(s) declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Global consumption of antifungal agents in 2018. DDD defined daily dose
Fig. 2
Fig. 2
A Consumption trend of antifungal agents in middle- versus high-income countries by agent (2008–2018). B Consumption of antifungal agents in high-income countries (2008–2018). DDD defined daily dose
Fig. 3
Fig. 3
Global consumption of antifungal agents in 2008 and 2018 in 65 countries. DDD defined daily dose
Fig. 4
Fig. 4
Consumption of antifungal agents by antifungal drug class in lower middle- and upper middle-income countries (2008–2018). Others includes flucytosine and terbinafine. DDD defined daily dose
Fig. 5
Fig. 5
Consumption trend of antifungal agents in middle- versus high-income countries by antifungal drug class (2008–2018). Others includes flucytosine and terbinafine. DDD defined daily dose
Fig. 6
Fig. 6
Consumption trend of fluconazole, itraconazole, and terbinafine in middle- versus high-income countries (2008–2018). Fluconazole, itraconazole, and terbinafine are the most commonly used antifungal agents. DDD defined daily dose
Fig. 7
Fig. 7
Consumption trend of echinocandins, imidazole, and polyenes in middle- versus high-income countries (2008–2018). The consumption of echinocandins, imidazole, and polyene were the lowest among antifungal drug classes. DDD defined daily dose
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