Rezafungin non-inferior to caspofungin in invasive candidiasis, achieving faster mycological eradication

Invasive candidiasis (IC) and candidaemia represent severe fungal infections associated with high mortality and morbidity. Current standard-of-care antifungals, while effective, often require daily administration, posing challenges for patient adherence and healthcare burden. The echinocandin class of antifungals, which includes caspofungin, targets fungal cell wall synthesis, but the need for daily dosing highlights a gap for less frequent, equally efficacious options. Rezafungin, a novel echinocandin, was developed with an extended half-life to enable weekly dosing, potentially improving patient outcomes and treatment convenience.

This post hoc pooled analysis evaluated data from 372 adult patients with candidaemia or invasive candidiasis from the Phase 2 STRIVE and Phase 3 ReSTORE trials (including the ReSTORE China cohort). Patients received either rezafungin 400 mg (loading dose) followed by 200 mg weekly or caspofungin 70 mg (loading dose) followed by 50 mg daily for up to 4 weeks. Primary endpoint was Day 30 all-cause mortality (ACM), with secondary endpoints including mycological response at Days 5 and 14, and time to negative blood cultures (TTNBC). Treatment-emergent adverse events were also assessed.

The pooled analysis included 179 patients on rezafungin and 193 on caspofungin. Day 30 all-cause mortality was 20% (33/161) for rezafungin versus 22% (39/178) for caspofungin, demonstrating non-inferiority with a weighted difference of -2.4% (95% confidence interval -11.2% to 6.4%). Mycological eradication rates were higher for rezafungin at Day 5 (73% vs. 65%) and comparable at Day 14 (70% vs. 68%).