An evaluation of Rezafungin: the latest treatment option for adults with candidemia and invasive candidiasis

ABSTRACT

Introduction

Invasive fungal infections, especially candidemia and invasive candidiasis, continue to cause substantial morbidity and mortality. In addition, the emergence of drug-resistant Candida species, notably C. glabrata and C. auris, along with limitations in available treatments, highlights the urgent need for novel, effective antifungal agents.

Areas covered

This review discusses the results of in vitro studies evaluating the spectrum and highlights the pharmacokinetic/pharmacodynamic properties. It also includes discussions on two key clinical studies that assess safety, tolerability, and efficacy.

Expert opinion

Rezafungin has demonstrated comparable efficacy to other echinocandins in two clinical studies and exhibits in vitro activity against a broad range of Candida species and Aspergillus spp. It has a favorable safety profile with minimal side effects, and no drug interactions or effects on QT intervals. In contrast to other echinocandins, it demonstrates dose-dependent killing, a prolonged half-life, and low clearance make it suitable for once-weekly dosing, which is supported by clinical trials confirming its efficacy. Rezafungin offers a promising option for the outpatient management of difficult to treat fungal infections. It has become a valuable addition to the antifungal arsenal, with the potential to reduce hospital length of stay and hospitalization costs and combat drug-resistant Candida species.

KEYWORDS:

• β-D-glucan inhibitor
• candidemia
• invasive candidiasis
• rezafungin
• long-acting echinocandin

Article highlights

• Rezafungin (Rzfgn) emerges as a promising second-generation echinocandin with strong in vitro effectiveness against drug-resistant Candida species, including C. glabrata and C. auris, as well as Aspergillus spp.

• Demonstrates exceptional pharmacokinetic properties including extended antifungal activity, superior tissue penetration, and anti-biofilm capabilities, facilitating once-weekly dosing.

• Clinical trials have validated Rzfgn’s efficacy, safety, and tolerability, positioning it on par with or superior to existing echinocandins.

• Features a distinguished safety profile with minimal side effects, no significant drug interactions, absence of hepatotoxicity, and no QT interval alteration.

• Holds promise for both treatment and prophylaxis of fungal infections in high-risk populations, such as bone marrow transplant recipients.

• Potentially reduces hospital stay costs and addresses critical challenges in antifungal treatment resistance and limited therapeutic options.

Declaration of interest

JA Vazquez has served on speaker bureaus for Astellas, Melinta, Abbvie; Consultant for F2G, Cidara, Melinta, Amplyx. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Acknowledgments

The contents of this publication are the sole responsibility of the authors.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.