# Rezafungin for Salvage or Consolidation Therapy of Invasive Fungal Disease: Experience in Real‐World Clinical Practice

## TL;DR

Rezafungin, a new once-weekly antifungal drug, was safely and effectively used in patients with invasive fungal disease who had already tried other treatments.

## Contribution

This study provides real-world evidence of rezafungin's efficacy and safety as salvage or consolidation therapy for invasive fungal disease.

## Key findings

- All evaluable patients achieved clinical cure with no treatment-emergent adverse events.
- Rezafungin was used primarily for fluconazole-resistant isolates and to avoid drug interactions.
- The drug was effective in treating deep-seated candidiasis in immunocompromised patients.

## Abstract

Echinocandins are the first‐line treatment for invasive candidiasis. Rezafungin is a novel echinocandin with improved pharmacokinetic properties that allow for once‐weekly intravenous administration, offering potential advantages in complex clinical settings.

We aimed to describe our real‐world experience with rezafungin for the treatment of invasive fungal disease (IFD).

A retrospective analysis of consecutive patients treated with rezafungin for proven IFD at our center between September 2022 and December 2025 was conducted.

We included 13 patients (mean age: 59.4 ± 17.8 years). Main predisposing conditions included immunosuppression (53.8% [solid organ transplantation in 30.8%]), solid cancer (30.8%) and recent surgical intervention (38.5%). Most frequent Candida species were
C. albicans
(38.5%),
C. parapsilosis
(30.8%) and Nakaseomyces glabratus (15.4%). One patient had necrotizing gingival infection due to Trichoderma longibrachiatum. Main types of IFD included intravascular Candida infection (38.5%) and surgical‐site and intra‐abdominal candidiasis (23.1% each). Reported reasons for initiating rezafungin were the presence of fluconazole‐resistant isolates (53.8%), facilitating outpatient antifungal therapy (30.8%) and avoiding anticipated drug–drug interactions with triazoles (15.4%). No patient received rezafungin as a first‐line treatment and most (92.3%) had been previously exposed to other echinocandins. Rezafungin was typically initiated upon clearance of follow‐up blood cultures (80.0%). Median number of weekly doses was 4.0 (interquartile range: 3.0–5.5). Clinical cure (complete or partial response) by day +30 was achieved in all evaluable patients (100.0% [12/12]), with no treatment‐emergent adverse events.

Rezafungin was effective and safe as salvage or consolidation therapy in patients with IFD, including deep‐seated candidiasis.