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Combination therapy for mucormycosis: why, what, and how?
Brad Spellberg1, Ashraf Ibrahim, Emmanuel Roilides
1Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, University of California at Los Angeles, 1124 West Carson St., Torrance, CA 90502, USA. bspellberg@labiomed.org
Summary
Novel antifungal combinations, particularly lipid polyene-echinocandin therapy, show promise for treating mucormycosis. Further clinical trials are essential to confirm superior outcomes compared to monotherapy for this serious fungal infection.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Mucormycosis has a high mortality rate, especially in hematology patients.
- Current monotherapy options are insufficient, necessitating research into combination therapies.
Purpose of the Study:
- To explore the potential of novel antifungal combination therapies for mucormycosis.
- To identify promising combination regimens and the need for definitive clinical trials.
Main Methods:
- Review of existing data on combination antifungal therapies.
- Evaluation of safety profiles, parenteral availability, and synergistic effects in preclinical models.
- Assessment of observational clinical data.
Main Results:
- Lipid polyene-echinocandin combination therapy is a promising regimen.
- Other potential combinations include lipid polyene with deferasirox or posaconazole.
- Synergy observed in murine models and concordant clinical data support these combinations.
Conclusions:
- Definitive randomized, placebo-controlled phase III trials are critically needed.
- Clarification is required to guide clinical decisions on using combination therapy versus monotherapy.
- Sponsorship for trials is essential to improve outcomes for devastating mucormycosis infections.
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