Hospitalized adults with candidemia or invasive candidiasis (C/IC) often remain inpatient to complete daily intravenous echinocandin therapy. Rezafungin, a once-weekly echinocandin, may facilitate earlier discharge in clinically stable patients. We evaluated its potential economic impact from a US hospital perspective.MethodA decision-analytic probabilistic model compared 2 treatment-discharge strategies in 100 hypothetical hospitalized adults with C/IC who had reached clinical stability and were otherwise dischargeable: continued inpatient daily echinocandin therapy until observed discharge versus administration of a single 400 mg dose of rezafungin with earlier discharge. The rezafungin strategy incorporated earlier discharge distributions from a multicenter US study. Costs included antifungal acquisition, inpatient hospitalization during the final 4 hospital days, and peripherally inserted central catheter (PICC)-related costs (2026 US dollars). Deterministic, threshold, and probabilistic sensitivity analyses (10 000 Monte Carlo simulations) were performed, focusing on excess hospital costs.ResultsIn the base case, mean excess cost was lower with rezafungin than standard of care (SOC) (−$412 vs $708 per patient), corresponding to savings of $1120 per patient. Savings were greater when SOC required PICC placement (−$2269) versus no PICC placement (−$851). Rezafungin was associated with higher costs when no earlier discharge occurred (+$3471) or discharge occurred only 1 day earlier (+$1475), but became cost saving with ≥2 days earlier discharge (−$556 at 2 days, −$2903 at 3 days, and −$5313 at ≥4 days).ConclusionsOnce-weekly rezafungin reduced hospital costs versus daily echinocandins when it enabled discharge ≥2 days earlier, with greater savings when PICC placement was avoided.

Review written by: Megan MaurielloCandida glabrata, now officially known as Nakaseomyces glabratus (Takashima and Sugita 2022), causes opportunistic infections, especially in immunocompromised people, and has a high mortality rate. It is among the most frequently antifungal-resistant Candida species. Echinocandin antifungals, including caspofungin, micafungin, anidulafungin, and rezafungin, inhibit fungal cell wall synthesis by inhibiting β-1,3-glucan synthase. Echinocandin resistance is usually

This pooled analysis of Phase 2 and Phase 3 data, including the China extension cohort, supports the efficacy and safety of rezafungin. Rezafungin was non-inferior to caspofungin, with earlier mycolog...

Background The efficacy and safety of rezafungin in invasive candidiasis (IC) and candidaemia was demonstrated in the Phase 2 STRIVE and Phase 3 ReSTORE trials, and an additional cohort of patients ...

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Invasive mycoses present significant medical challenges, with new populations at risk and the emergence of antifungal resistance. Therapeutic options …

Candidozyma auris (C. auris) is a resistant fungal pathogen with high mortality.ObjectivesTo evaluate the in vitro activity of 11 antifungal agents against C. auris from multiple hospitals.MethodsMIC was determined by microdilution testing for amphotericin B, anidulafungin, caspofungin, manogepix, micafungin, rezafungin and five triazoles. Sanger sequencing was performed on one echinocandin resistant isolate.ResultsThere were 84 C. auris isolates from Michigan that were compared with 27 organisms from external sources. Manogepix had the lowest MIC90 (0.03 mg/L). The next most active agent was micafungin. The echinocandins demonstrated a 98.8% susceptibility. A single isolate was found to have a S639F mutation. Amphotericin B demonstrated a 97.6% susceptibility. The MIC90 demonstrated values of ≤0.5 mg/L for isavuconazole, itraconazole and posaconazole. When separating by colonization versus infection isolates, the MIC90 values were identical for all agents, except micafungin, which showed 0.25 versus 0.12 mg/L, respectively. When comparing the reference isolates with Michigan isolates, the MIC90 was identical for echinocandins and manogepix. Differences noted were with amphotericin B, for which 85.2% were susceptible for reference isolates compared to 97.6% from Michigan isolates, and fluconazole, where 25.9% were susceptible for the reference isolates compared with 4.8% from Michigan isolates.ConclusionsManogepix and echinocandins demonstrated the greatest activity against C. auris irrespective of hospital and were like the reference isolates. Amphotericin B demonstrated greater activity compared with published studies. Fluconazole has poor activity; the activity of other triazoles remains unclear.

Guidelines recommend ≥2 weeks of antifungal therapy after candidemia clearance and for invasive candidiasis (IC). This post-hoc analysis evaluates Day 7 pooled data from the phase 2 STRIVE and phase 3 ReSTORE trials to explore early antifungal activity.MethodsAdults with candidemia and/or IC received weekly rezafungin 400/200 mg or daily caspofungin 70/50 mg for ≤4 weeks. Efficacy was evaluated in the modified intent-to-treat population via all-cause mortality (ACM; primary endpoint; 20% noninferiority margin), mycological eradication, and time to negative blood culture (TTNBC) at days 7, 14, and 30 (TTNBC assessed only in patients with candidemia). Day 7 safety was evaluated in the safety population.ResultsRezafungin was noninferior to caspofungin at each timepoint. Day 7 ACM rates were 7.9% (11/139) for rezafungin and 5.2% (8/155) for caspofungin (weighted difference [95% CI]: 3.0% [−3.7, 9.7]). Mycological eradication was similar between groups at all timepoints. Day 7 rates were 71.2% (99/139) and 65.2% (101/155), respectively (weighted difference [95% CI]: 6.6% [−4.0, 17.1]). Median (interquartile range) TTNBC was numerically shorter for rezafungin (22.3 [14.3–47.0] hours; caspofungin 26.3 [17.8–112.6] hours). Subgroup analyses suggested potential Day 7 benefits for rezafungin in patients with candidemia or C. albicans. Day 7 safety for rezafungin was consistent with previous reports.ConclusionsRezafungin was noninferior to caspofungin in candidemia and/or IC from Day 7, with shorter TTNBC in patients with candidemia. Subgroup analysis suggested a potential early benefit with rezafungin in some patients. Trials exploring shorter treatment durations for some patients are warranted.Clinical trials registrationsNCT02734862 (STRIVE); NCT03667690 (ReSTORE).

ABSTRACTTo evaluate the safety and efficacy of echinocandins (rezafungin, RZF; anidulafungin, AFG) in Candida albicans (C. albicans) endophthalmitis, with a particular focus on the novel drug RZF. In vitro safety was assessed by CCK-8 and live/dead staining on ARPE-19, Müller, and RAW 264.7. For in vivo safety, we administered therapeutic doses via intravitreal injection in rabbit eyes and performed fundus photography and histopathological analysis on day 3. Antifungal effect evaluation included minimum inhibitory concentration (MIC) determination, biofilm inhibition, and structural damage observation (confocal laser scanning microscopy, CLSM; scanning/transmission electron microscopy, SEM/TEM). We measured inflammatory responses via TNF-α/IL-1β qRT-PCR in RAW 264.7 cells. A rabbit C. albicans endophthalmitis model was established. At 48 h post-infection, rabbits received intravitreal injections of liposomal amphotericin B (L-AmB, 10 μg), voriconazole (VCZ, 50 μg), RZF (35 μg), AFG (35 μg), or saline (control). Clinical scores, ocular fungal burden, aqueous humor TNF-α, and histopathological scores were assessed. Echinocandins showed lower IC50 values in vitro, yet maintained acceptable safety at clinically relevant low concentrations compared with traditional drugs, with no significant tissue toxicity in vivo. RZF and AFG exhibited lower MICs (0.016–0.03125 μg/mL) than L-AmB (4 μg/mL) and VCZ (0.125–0.25 μg/mL). All four drugs inhibited biofilm formation, disrupted fungal structures, and downregulated inflammatory responses. In vivo, RZF/AFG reduced clinical and histopathological scores, fungal burden, and TNF-α levels, performing similarly to traditional drugs. RZF and AFG demonstrate potent antifungal activity against C. albicans comparable to conventional drugs, along with significant anti-inflammatory effects and acceptable safety profiles.

AbstractBackground. Guidelines recommend ≥2 weeks of antifungal therapy after candidemia clearance and for invasive candidiasis (IC). This post-hoc analysi

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Rezafungin, der neueste Echinocandinvertreter. Gezielt eingesetzt, klug entschieden, bessere Ergebnisse. Candida auris. Pneumocystis jirovecciii. Aspergillus & Candida.

Trichoderma is a genus of rare filamentous fungi that can cause invasive fungal infections in immunocompromised patients. We report a case of necrotizing gingiv...

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AbstractTrichoderma is a genus of rare filamentous fungi that can cause invasive fungal infections in immunocompromised patients. We report a case of necrotizing gingival and sinus infection due to T. longibrachiatum in an allogeneic stem cell transplant recipient. The patient received a combination of antifungal and aggressive surgical debridement, achieving clinical cure. The treatment included amphotericin B, voriconazole and caspofungin with the latter switch to rezafungin to consolidate therapy. Rezafungin might represent a useful alternative for fungal infections with limited therapeutic options, but further studies are needed to confirm its role in Trichoderma spp. infections.

Rezafungin (RZF), a novel long-acting intravenous echinocandin, was approved by the FDA in March 2023 for adult patients (pts) with candidemia and invasive candidiasis and safety data for up to 4 weekly doses. The once weekly dosing regimen is advantageous in outpatient settings, eliminating the requirement for central venous catheters and daily medication administration.Table 1.Demographics and Baseline CharacteristicsFigure 1.Pathogens in RZF Treatment CoursesMethodsRezafungin (RZF), a novel long-acting intravenous echinocandin, was approved by the FDA in March 2023 for adult patients (pts) with candidemia and invasive candidiasis and safety data for up to 4 weekly doses. The once weekly dosing regimen is advantageous in outpatient settings, eliminating the requirement for central venous catheters and daily medication administration.Figure 2.Clinical Outcomes in RZF Treatment CoursesResults50 pts received 55 treatment courses from 9/2023 to 3/2025, with characteristics in Table 1. Median age was 62 years (IQR 53-74). 20 pts (40%) received RZF following hospitalization. Median Charlson Comorbidity Index was 4 (IQR 2-6). 36 pts (72%) had risk factors for fungal infections and 48 (96%) had prior anti-fungal therapy, including all those with mucosal candidiasis. Initial dose was 400 mg and the median number of weekly doses received was 2 (IQR 2-4). RZF was used to treat candidemia (n=11), invasive candidiasis (n=15), or mucosal candidiasis (n=29). Pathogens are noted in Figure 1. Candida glabrata was the predominant organism. Out of 55 treatment courses, clinical success overall was achieved in 50 patient treatment courses (91%), with non-success in 3 (5%) and 2 (4%) non-evaluable. Outcomes are displayed in Figure 2, including those by diagnostic group. Non-serious adverse events occurred in 4 (7%) treatments, none requiring discontinuation.ConclusionRZF was a safe, tolerable, and effective treatment for candidemia and candidiasis in this treatment experienced comorbid population. This real-world data establishes the successful use of a long-acting weekly echinocandin in the outpatient treatment of patients with fungal infections.DisclosuresRichard L. Hengel, MD, FIDSA, Gilead: Grant/Research Support Brian S. Metzger, MD, MPH, Abbvie: Advisor/Consultant|Cumberland Pharmaceuticals: Advisor/Consultant|Ferring Pharmaceuticals: Advisor/Consultant Lucinda J. Van Anglen, PharmD, FIDSA, Cumberland Pharmaceuticals: Grant/Research Support|Ferring Pharmaceuticals: Grant/Research Support|Melinta Therapeutics: Grant/Research Support|Novartis: Grant/Research Support|Takeda Pharmaceuticals: Grant/Research Support

AbstractBackground. Chronic pulmonary aspergillosis (CPA) is a serious lung disorder caused by Aspergillus fungal infection with high morbidity and mortali