Rezafungin: A Review in Invasive Candidiasis

Rezafungin (Rezzayo^®) is a next-generation echinocandin antifungal with improved pharmacokinetic properties over first-generation echinocandins that allows for once-weekly rather than once-daily intravenous administration. It has recently been approved for the treatment of adults with invasive candidiasis in the EU and UK, and is approved for adults who have limited or no alternative options for the treatment of candidaemia and invasive candidiasis in the USA. In the pivotal phase 3 ReSTORE trial, rezafungin was non-inferior to caspofungin (a first-line echinocandin antifungal agent) based both on global cure rates at day 14 and all-cause mortality rates at day 30 in adults with candidaemia or invasive candidiasis. Additionally, the once-weekly administration of rezafungin has the potential advantage of front-loading the dose and increasing drug exposure, with some evidence suggesting that rezafungin may achieve earlier infection clearance relative to caspofungin. Rezafungin was generally well tolerated, with the most common treatment-emergent adverse events being hypokalaemia, pyrexia, diarrhoea and anaemia. Therefore, rezafungin is a useful addition to the treatments currently available for invasive candidiasis in adults, with potential benefits associated with less frequent administration compared with first-generation echinocandins.