How urgent is the need for new antifungals?

ABSTRACT

Introduction: Invasive fungal infection carries a high morbidity, mortality and economic cost. In recent times, a rising incidence of fungal infection and antifungal resistance is occurring which has prompted the development of novel antifungal agents.

Areas covered:In this perspective, the authors describe the current status of registered antifungals and their limitations in the treatment of invasive fungal infection. They also go on to describe the new antifungal agents that are in the clinical stage of development and how they might be best utilized in patient care in the future.

Expert opinion: The antifungal drug development pipeline has responded to a growing need for new agents to effectively treat fungal disease without concomitant toxicity or issues with drug tolerance. Olorofim (F901318), ibrexafungerp (SCY-078), fosmanogepix (APX001), rezafungin (CD101), oteseconazole (VT-1161), encochleated amphotericin B (MAT2203), nikkomycin Z (NikZ) and ATI-2307 are all in the clinical stage of development and offer great promise in offering clinicians better agents to treat these difficult infections.

KEYWORDS:

• Candida
• Aspergillus
• antifungal
• Scedosporium

Article highlights

• Invasive fungal infection carries a high morbidity and mortality, and carries a large global burden of disease.

• Antifungal resistance is a growing concern globally, especially with regards to C. auris and azole-resistant A. fumigatus species.

• Current registered and available antifungals are inadequate to meet the emerging burden of disease due to their significant limitations.

• Novel antifungals in the clinical trial stages of development hold immense promise.

• Agents with favourable safety and tolerability, with minimal drug-drug interactions, good pharmacokinetic profile and broad spectrum of activity are greatly needed.

Declaration of interest

DL Paterson has received funding from AstraZeneca, Leo Pharmaceuticals, Bayer, GlaxoSmithKline, Cubist, Venatorx and Accelerate; reports board membership from Entasis, Qpex, Merck & Co, Shionogi, Achaogen, AstraZeneca, Leo Pharmaceuticals, Bayer, GlaxoSmithKline, Cubist, Venatorx, and Accelerate; reports grants/grants pending from Shionogi and Merck & Co.; and has received payment for lectures including service on speaker’s bureaus from Pfizer, outside the submitted work. A Stewart and DL Paterson are investigators in a trial of olorofim. Dr Paterson is also an investigator in a trial of rezafungin. 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.

Reviewer disclosures

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

Additional information

Funding

This manuscript was not funded.