Exploring Early Antifungal Activity of Rezafungin as a Stepping-Stone for Shorter Treatment Duration for Candidemia: Pooled Analysis of 2 Randomized Trials

Authors

• Luis Ostrosky-Zeichner
• Jalal A Aram
• Mark Redell
• George R Thompson
• Oliver A Cornely
• James A McKinnell
• Andrej Spec
• Peter G Pappas

Language

English

Publication Date

4-1-2026

DOI

10.1093/ofid/ofag143

PMID

41940006

PMCID

PMC13048901

PubMedCentral® Posted Date

3-21-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Guidelines recommend ≥2 weeks of antifungal therapy after candidemia clearance and for invasive candidiasis (IC). This post-hoc analysis evaluates Day 7 pooled data from the phase 2 STRIVE and phase 3 ReSTORE trials to explore early antifungal activity.

Methods: Adults with candidemia and/or IC received weekly rezafungin 400/200 mg or daily caspofungin 70/50 mg for ≤4 weeks. Efficacy was evaluated in the modified intent-to-treat population via all-cause mortality (ACM; primary endpoint; 20% noninferiority margin), mycological eradication, and time to negative blood culture (TTNBC) at days 7, 14, and 30 (TTNBC assessed only in patients with candidemia). Day 7 safety was evaluated in the safety population.

Results: Rezafungin was noninferior to caspofungin at each timepoint. Day 7 ACM rates were 7.9% (11/139) for rezafungin and 5.2% (8/155) for caspofungin (weighted difference [95% CI]: 3.0% [-3.7, 9.7]). Mycological eradication was similar between groups at all timepoints. Day 7 rates were 71.2% (99/139) and 65.2% (101/155), respectively (weighted difference [95% CI]: 6.6% [-4.0, 17.1]). Median (interquartile range) TTNBC was numerically shorter for rezafungin (22.3 [14.3-47.0] hours; caspofungin 26.3 [17.8-112.6] hours). Subgroup analyses suggested potential Day 7 benefits for rezafungin in patients with candidemia or C. albicans. Day 7 safety for rezafungin was consistent with previous reports.

Conclusions: Rezafungin was noninferior to caspofungin in candidemia and/or IC from Day 7, with shorter TTNBC in patients with candidemia. Subgroup analysis suggested a potential early benefit with rezafungin in some patients. Trials exploring shorter treatment durations for some patients are warranted.

Keywords

candidemia, early efficacy, invasive candidiasis, rezafungin, treatment duration

Comments

Clinical trials registrations: NCT02734862 (STRIVE); NCT03667690 (ReSTORE).

Published Open-Access

yes

Recommended Citation

Ostrosky-Zeichner, Luis; Aram, Jalal A; Redell, Mark; et al., "Exploring Early Antifungal Activity of Rezafungin as a Stepping-Stone for Shorter Treatment Duration for Candidemia: Pooled Analysis of 2 Randomized Trials" (2026). Faculty, Staff and Student Publications. 3682.
https://digitalcommons.library.tmc.edu/uthmed_docs/3682