Reinhold Ilana, Mori Giovanni, Lanzafame Massimiliano, Limongelli Alessandro, Vena Antonio, Götz Julia, Bauernfeind Stilla, Hanses Frank, Tometten Lukas, Mayer Michael, Rieke Ansgar, Soriano-Martin Ana, Valerio Maricela, Vazquez Jose A, Yue Patrick, Rahimli Laman, Azimli Nijat, Sal Ertan, Salmanton-García Jon, Vasenda Natalia, Sprute Rosanne, Stemler Jannik, Wingen-Heimann Sebastian, Cornely Oliver A, Seidel Danila
Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, Cologne, Germany.
Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
Mycoses. 2025 Sep;68(9):e70114. doi: 10.1111/myc.70114.
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.
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.
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.
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.
瑞扎芬净是一种新型棘白菌素，每周静脉给药一次，为侵袭性念珠菌病（IC）的门诊肠外抗真菌治疗（OPAT）提供了潜在优势。虽然临床试验数据支持其疗效和安全性，但真实世界的经验仍然有限。
对2024年1月至2025年6月期间在德国、意大利、西班牙和美国接受瑞扎芬净治疗的患者进行回顾性分析。数据通过FungiScope登记处收集。评估了临床特征、瑞扎芬净的适应症、结局、安全性和给药的后勤方面。
纳入15例患者，14例患有IC；1例患有慢性肺曲霉病。在IC患者中，中位年龄为65.5岁；43%为女性。最常鉴定出的病原体是光滑念珠菌（57%）和近平滑念珠菌（21%）。瑞扎芬净的主要适应症是血管内感染（36%）和骨关节炎感染（36%）。选择瑞扎芬净主要是为了实现OPAT（86%），或由于氟康唑耐药（36%）或药物相互作用（14%）。中位治疗持续时间为9周（范围：1 - 38周）。发生了1例轻度不良事件（皮肤光敏反应），但瑞扎芬净在其他方面耐受性良好。在第30天，36%的患者观察到完全临床或真菌学缓解，50%的患者观察到部分缓解。由于行政和报销障碍，各中心的获取情况差异很大，71%的IC患者的治疗转换为瑞扎芬净受到影响。
瑞扎芬净在该队列中有效且耐受性良好，特别是在需要长期治疗的患者中。行政和后勤障碍仍然是其广泛使用的重大障碍。通过支持早期开始治疗和护理的连续性，便利的获取途径和提高的认识可能会改善患者结局。
