Novel Therapeutic Approaches to Invasive Candidiasis: Considerations for the Clinician

Invasive candidiasis (IC), due to the yeast pathogen Candida, is still a major cause of in-hospital morbidity and mortality. The limited number of antifungal drug classes and the emergence of multi-resistant Candida species, such as Candida auris and some Candida glabrata isolates, is concerning. However, recent advances in antifungal drug development provide promising perspectives for the therapeutic approach of IC. Notably, three novel antifungal agents, currently in Phase II/III clinical trials, are expected to have an important place for the treatment of IC in the future. Rezafungin is a novel echinocandin with prolonged half-life. Ibrexafungerp and fosmanogepix are two first-in-class antifungal drugs with broad spectrum activity against Candida spp., including C. auris and echinocandin-resistant species. These novel antifungal agents also represent interesting alternative options because of their acceptable oral bioavailability (ibrexafungerp and fosmanogepix) or their large interdose interval (once weekly intravenous administration for rezafungin) for prolonged and/or outpatient treatment of complicated IC. This review discusses the potential place of these novel antifungal drugs for the treatment of IC considering their pharmacologic properties and their preclinical and clinical data.

Automated summary

Invasive candidiasis (IC) caused by Candida remains a significant cause of morbidity and mortality in hospitals. The emergence of drug-resistant Candida species raises concerns due to the limited number of antifungal drugs available. However, recent advances in antifungal drug development offer promising prospects for IC treatment. Three novel antifungal agents, Rezafungin, Ibrexafungerp, and Fosmanogepix, currently in Phase II/III clinical trials, are expected to play an important role in future IC treatment. This review discusses the pharmacological properties and preclinical and clinical data of these novel antifungal drugs.