Rezafungin Utilisation in Real Life-FungiScope Results From Europe and the United States

Abstract

Background: Rezafungin, a novel echinocandin with once-weekly intravenous dosing, offers potential advantages for outpatient parenteral antifungal therapy (OPAT) in invasive candidiasis (IC). While clinical trial data support its efficacy and safety, real-world experience remains limited.

Methods: A retrospective analysis of patients treated with rezafungin across Germany, Italy, Spain, and the United States between January 2024 and June 2025 was conducted. Data was collected via the FungiScope registry. Clinical characteristics, indications for rezafungin, outcomes, safety, and logistical aspects of administration were evaluated.

Results: Fifteen patients were included, fourteen with IC; one with chronic pulmonary aspergillosis. Regarding patients with IC, the median age was 65.5 years; 43% were female. The most frequently identified pathogens were Candida glabrata (57%) and Candida parapsilosis (21%). Primary indications for rezafungin were intravascular (36%) and osteoarticular infections (36%). Rezafungin was mainly selected to enable OPAT (86%) or due to fluconazole resistance (36%) or drug-drug interactions (14%). The median treatment duration was 9 weeks (range: 1-38 weeks). One mild adverse event occurred (cutaneous photosensitivity), but rezafungin was otherwise well tolerated. Complete clinical or mycological response was observed in 36% at day 30, and partial response in 50% of patients. Access differed substantially across centres due to administrative and reimbursement hurdles, affecting treatment transition to rezafungin in 71% of patients with IC.

Conclusions: Rezafungin was effective and well tolerated in this cohort, particularly in patients requiring long-term treatment. Administrative and logistical hurdles remain significant barriers to its widespread use. Facilitated access and enhanced awareness may improve patient outcomes by supporting early initiation and continuity of care.

Keywords: antifungal treatment; candidemia; chronic pulmonary aspergillosis; invasive candidiasis.

FIGURE 1

Indications for rezafungin administration in 15 patients, and antifungal therapies administered prior to and following rezafungin initiation (icons adapted from biorender.com).

FIGURE 2

(A) Patient 9, initial PET‐CT scan showing increased tracer uptake (standardised uptake value, SUVmax 6) around the aortic root and in the anterior mediastinal fat (SUVmax 5), with hypermetabolic lymph nodes in the paratracheal and precarinal regions (SUVmax 5). Clinically, a sternal wound infection, mediastinitis and possible prosthetic aortic endocarditis with fluconazole‐resistant C. parapsilosis were concluded. (B) Patient 9, follow‐up PET‐CT 5.5 months later, after 23 weeks of rezafungin treatment, showing minimal heterogeneous tracer uptake (SUVmax 3.7) in the periaortic hypodense area and anterior mediastinal fat consolidation. Moderate uptake remains at the median sternotomy site. Compared to the prior PET‐CT, findings are reduced in extent and metabolic activity. The next PET‐CT is scheduled 3 months later; the patient remains under rezafungin until then.

FIGURE 3

(A) Patient 10, initial CT scan on postoperative day five after low anterior resection of the rectum, showing a seroma of 57 mm. Culture of the collection fluid grew C. glabrata . (B) Patient 10, follow‐up CT scan on postoperative day 38 after three weeks of rezafungin therapy, showing a reduction of the seroma to 21 mm. Surgical intervention was not pursued, as the collection was self‐draining into the rectal stump.