Micafungin as antifungal prophylaxis in non-transplanted haemotological patients

Villaescusa, Teresa; Vázquez, Lourdes; Bergua, José María Bedoya; García, Jesús Rodríguez; Romero, A.; Olave, M T; Belmonte, Daniel García; Llano, Maria Paz Queipo De

doi:10.37201/req/067.2019

Cited by 3 publications

(1 citation statement)

References 27 publications

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“…While all three echinocandins have been studied in various patient populations ( 13 , 43 – 48 ), only micafungin is indicated for use as antifungal prophylaxis, specifically, of Candida infections in adult and pediatric patients undergoing hematopoietic stem cell transplantation ( 12 , 49 , 50 ). In a retrospective study in patients with hematological disease who received antifungal prophylaxis, micafungin was selected in 26% of 104 cases for safety- or tolerability-related reasons (e.g., liver dysfunctions, severe mucositis, DDIs of other antifungals, and long QT syndrome) ( 51 ). The safety of rezafungin is consistent with that of the echinocandin class, as observed in the phase 2 STRIVE trial of once-weekly rezafungin compared to caspofungin in the treatment of candidemia and invasive candidiasis ( 35 , 52 ) and in phase 1 trials that confirmed rezafungin lack of effect on the QT interval and low DDI potential ( 37 , 38 ).…”

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confidence: 99%

Efficacy of Rezafungin in Prophylactic Mouse Models of Invasive Candidiasis, Aspergillosis, and Pneumocystis Pneumonia

Miesel¹,

Cushion

Ashbaugh

et al. 2021

Antimicrob Agents Chemother

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Antifungal prophylaxis is recommended to prevent invasive fungal disease caused by Candida spp., Aspergillus spp., and Pneumocystis jirovecii in patients at risk for opportunistic infections, such as allogeneic blood or marrow transplant recipients, patients with hematological disease undergoing chemotherapy, or patients on immunosuppressive therapies. Current approaches to antifungal prophylaxis require multiple agents to cover these key fungi. Rezafungin, a novel echinocandin designed for next-generation properties (e.g., greater stability and long-acting pharmacokinetics for once-weekly dosing), has demonstrated in vitro activity against Candida and Aspergillus spp. and efficacy against Pneumocystis spp. biofilms. Rezafungin was evaluated in in vivo studies of prophylactic efficacy using immunosuppressed mouse models of invasive candidiasis, aspergillosis, and Pneumocystis pneumonia. Rezafungin reduction of Candida CFU burden was generally greater with increasing drug concentrations (5, 10, or 20 mg/kg) and when rezafungin was administered closer to the time of fungal challenge (Days –1,–3, or–5). Similarly, in the aspergillosis model, survival rates increased with drug concentrations and when rezafungin was administered closer to the time of fungal challenge. Against P. murina, rezafungin significantly reduced trophic nuclei and asci counts at all doses tested. Rezafungin prevented infection at the 2 higher doses when compared with vehicle and had comparable activity to the active control trimethoprim-sulfamethoxazole at human equivalent doses for prevention. These findings support Phase 3 development of rezafungin and the potential for single-agent prophylaxis against invasive fungal disease caused by Candida spp., Aspergillus spp., and Pneumocystis jirovecii.

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