Rezafungin for Invasive Candidiasis

Enchinocandin antifungals are the first choice for therapy of invasive candidiasis, although current formulations require daily dosing. Rezafungin, a new echinocandin with a broad range of activity and a half-life of 133 hours, may present advantages over the available echinocandins. A consortium of international investigators performed a multicenter, prospective, double-blind, noninferiority phase 3 study from October 2018 through August 2021 to assess weekly IV rezafungin compared with daily IV caspofungin followed by optional step-down oral fluconazole in adult patients with candidemia or invasive candidiasis. Participants received treatment for a minimum of 14 days. The study was funded by the manufacturer of rezafungin.

Among 187 subjects, global cure rates at day 14 were 59% (rezafungin) and 61% (caspofungin) and all-cause 30-day mortality was 24% and 21%. For both of these predefined endpoints, rezafungin was noninferior to caspofungin. Among those with candidemia, median time to negative culture was 23.9 hours for rezafungin compared with 27.0 hours for caspofungin (p=0.18). Serious adverse events were similar between groups.