Rezafungin acetate for the treatment of candidemia and invasive candidiasis: a pharmacokinetic evaluation

Introduction: Rezafungin, formerly SP3025 and CD101, is a next-generation echinocandin, chemically related to anidulafungin, with differentiated pharmacokinetic characteristics, including a prolonged half-life allowing extended-interval dosing. Areas covered: Herein, we discuss the role of rezafungin in the treatment of candidemia and invasive candidiasis, with a specific focus on pharmacokinetics considerations. Expert opinion: Rezafungin exhibits potent in vitro activity against most wild-type and azole-resistant Candida species, including Candida auris. The differentiated PK characteristics of rezafungin which enables once weekly dosing could reduce catheter overuse and provide a rapid transition to outpatient treatment for Candida infections in which azoles cannot be used, due to resistance or drug-drug interactions. Besides weekly dosing, other potential pharmacokinetic/pharmacodynamic advantages of rezafungin are its good penetration into anatomically challenging sites and a potentially reduced probability of local resistance promotion, making it an attractive option also for deep-seated infections that could warrant dedicated clinical investigation.