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Rezafungin versus caspofungin for treatment of candidaemia and invasive candidiasis

Lancet, 2023 · Multicentre, double-blind, double-dummy phase 3 randomized noninferiority trial.

Clinical question

Is once-weekly rezafungin noninferior to daily caspofungin for candidemia/invasive candidiasis?

Population: 199 adults with candidemia and/or invasive candidiasis in the phase 3 trial.
Intervention: Rezafungin once weekly (front-loaded 400 mg then 200 mg weekly).
Comparator: Caspofungin daily, with protocol-specified step-down where appropriate.
Primary outcome: Day-30 all-cause mortality (FDA endpoint) and global cure analyses.
Result: Rezafungin met prespecified noninferiority criteria versus caspofungin, with a broadly similar safety profile.

What the trial found

Once-weekly rezafungin provided efficacy noninferior to daily caspofungin in the studied candidemia/invasive-candidiasis population.

Current guideline position

Post-dates IDSA 2016 candidiasis guideline; use according to current local approval/formulary and susceptibility context.

Clinical interpretation

Rezafungin is a newer echinocandin option, but FDA labeling is restricted to patients with limited or no alternative treatment options; it does not make conventional echinocandins obsolete.

High certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Candidemia & Invasive Candidiasis

ICU recognition and treatment of candidemia and invasive candidiasis, including source control, repeat cultures, step-down therapy and metastatic infection.

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