Rezafungin vs caspofungin for the treatment of invasive candidiasis: A systematic review and meta-analysis

Severe fungal infection known as invasive candidiasis primarily impacts critically ill alongside immunocompromised patients with high mortality and long hospital stays and creates substantial healthcare expenses. Echinocandins constitute the current standard first-line treatment for invasive candidiasis, with caspofungin being among the most widely used agents, caspofungin is used to treat invasive candidiasis but requires daily intravenous administration, and its pharmacokinetics may vary between patients. A new generation echinocandin antifungal drug called Rezafungin demonstrates an extended half-life through which medical personnel can administer treatment only once per week to improve patient adherence and minimize healthcare costs. This review aimed to compare rezafungin and caspofungin to evaluate their efficacy and safety, and to explore whether rezafungin's pharmacokinetics offer clinical advantages.

We conducted a systematic review and meta-analysis of randomized controlled trials comparing rezafungin and caspofungin for invasive candidiasis in adults. Studies were selected based on predefined PICOS criteria and sourced from PubMed, Scopus, Embase, Web of Science, and Cochrane Library. After removing duplicates using Rayyan, four eligible trials involving adult patients were included. Data on efficacy and safety outcomes were extracted. Risk of bias was assessed using ROB 2, and meta-analysis was performed using RevMan 5.4 to calculate risk ratios with 95 % confidence intervals.

Four RCT with 677 patients included in our systematic review and meta-analysis. The pooled analysis revealed no statistically significant differences between rezafungin and caspofungin in key outcomes. Global cure at day 14 was similar between the two groups (RR = 1.04, 95 % CI: 0.90-1.20, p = 0.45), as were the rates subgroup anaylsis of blood culture negativity at 24 and 48 h and mycological eradication, and safety outcomes such as, Patients with ≥1 treatment-emergent adverse event, abdominal pain, hypokalemia, acute kidney injury, septic shock, and all-cause mortality at day 30.

Rezafungin is noninferior to caspofungin in the treatment of invasive candidiasis, offering equivalent efficacy and safety outcomes. Its once-weekly dosing regimen presents potential advantages in terms of improved patient adherence and reduced healthcare resource utilization. Future research should focus on larger, more diverse populations and longer follow-up durations to further elucidate the long-term benefits and cost-effectiveness of rezafungin.