Science & health
MHRA warns CRRT filters can reduce antifungal effectiveness in critically ill patients
The UK medicines regulator warns that polyacrylonitrile filters used in continuous renal replacement therapy can adsorb antifungals such as caspofungin, potentially making treatment ineffective in critically ill patients. The risk is considered greatest when a new filter or circuit begins, then declines as the membrane becomes saturated. Where clinically appropriate, the MHRA recommends giving echinocandins at least six hours after CRRT starts or after circuit changes, while not delaying clinically necessary CRRT.
Editorial summary · Publisher article
What matters
- The alert concerns CRRT, a 24-hour dialysis method commonly used for unstable intensive-care patients.
- The evidence indicates adsorption is highest with new PAN-based membranes and declines over time.
- The MHRA says clinicians should consider filter adsorption when patients show sub-therapeutic or absent treatment response.
- The UK recommendation differs from a broader European proposal because avoiding echinocandins may create serious clinical problems.
Why the UK advice differs
The MHRA reviewed European recommendations alongside newer studies and clinical input. It judged that avoiding echinocandins or PAN filters was not feasible in UK practice and could be harmful because echinocandins are important first-line treatments and alternatives may be limited by resistance or sensitivities.
Context & caveats
- The alert says comparative studies for other membrane types are lacking, so adsorption cannot be conclusively excluded beyond PAN-based filters.
Why this made the edition
The MHRA safety alert provides specific evidence, mechanism, clinical implications and operational guidance for intensive-care treatment involving CRRT and antifungal drugs.
Source material