🧾 Rezafungin: A New Antifungal Being Trialled for CPA

Some people with chronic pulmonary aspergillosis (CPA) have trouble tolerating standard antifungal medications. Commonly used drugs like voriconazole and posaconazole can cause serious side effects such as hallucinations, liver enzyme disturbances, or gut problems. When these medications can’t be used, options become limited.

A new antifungal, rezafungin, is now being studied as a possible treatment for CPA — especially in people who can’t tolerate azoles. It is not yet approved for aspergillosis, but a major clinical trial is under way.

🧬 What Is Rezafungin?

Rezafungin is part of a newer group of antifungal drugs called echinocandins. These work by weakening the fungal cell wall — a very different mechanism to azole drugs like itraconazole or voriconazole.

Key features:

• Given as a weekly intravenous (IV) drip

• Long-acting: stays in the body for days after each dose

• Designed to provide high drug levels in the lungs and bloodstream

• Early studies show less frequent side effects than with some older antifungals

It is already licensed for treatment of Candida bloodstream infections but is being studied now for CPA.

🧪 Current Research: Trial for CPA

A clinical trial is currently recruiting people with CPA who:

• Cannot take azole antifungals because of side effects or resistance

• Need alternative or combination therapy

This trial (called REZAFUNGin Efficacy and Safety for Aspergillus – CPA) is being conducted in the UK and internationally. The goal is to test whether rezafungin is safe and effective in CPA patients who have few remaining options.

🔗 View the clinical trial (NCT06794554)

📊 What Have Previous Studies Found?

While studies in CPA are just beginning, previous trials in other fungal infections provide important clues:

✅ Phase 2 & 3 Studies (Candida Infections)

• Rezafungin was found to be as effective as daily echinocandins (like caspofungin)

• Once-weekly dosing worked just as well as daily treatment

• Side effects were mild, and liver toxicity was rare

• No CNS side effects (like hallucinations) were reported

🧫 Laboratory Evidence

• Rezafungin is active against Aspergillus fumigatus, including some azole-resistant strains

• It reaches good levels in lung tissue — an important feature for CPA

• May be used alone or with another antifungal in complex cases

🩺 Case Example

A recent case report described successful treatment of chronic pulmonary aspergillosis using rezafungin plus voriconazole in a patient with resistant infection (Oxford University Press, 2024).

⚠️ Is Rezafungin Available Now?

Not yet. Rezafungin is only available for CPA:

• Through a clinical trial, or

• By special approval for compassionate use in selected cases

It is not currently licensed for aspergillosis in the UK or elsewhere.

💬 What Should I Discuss with My Doctor?

If you’re considering participation in a clinical trial or if standard treatments have failed, you might ask:

• Am I eligible for the rezafungin CPA trial?

• What are the benefits and risks of trying this treatment?

• Will I still need other antifungals (e.g. azoles or amphotericin)?

• How often will I need blood tests and hospital visits?

• Will this help if I have azole resistance or liver side effects?

📌 Summary

Rezafungin is a new antifungal drug being tested for people with chronic pulmonary aspergillosis who cannot take older treatments. It offers once-weekly dosing and early signs suggest a favourable safety profile, including in patients with liver concerns or those who had side effects from azoles.

Although not yet widely available, it may offer hope for people with limited options. If you or someone you know is struggling with antifungal intolerance, you may wish to speak to your medical team about the CPA clinical trial or explore compassionate access routes.

👉 Learn more or check trial sites:
🔗 https://clinicaltrials.gov/study/NCT06794554