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The following is a summary of “Rezafungin versus caspofungin for patients with candidaemia or invasive candidiasis in the intensive care unit: pooled analyses of the ReSTORE and STRIVE randomized trials,” published in the October 2024 issue of Critical Care by Honoré et al. 

Researchers conducted a retrospective study assessing patients under ICU with candidaemia and/or invasive candidiasis treated with rezafungin vs caspofungin. 

They conducted randomized, double-blind trials (STRIVE and ReSTORE) in ICU patients with confirmed candidaemia/IC, who received either rezafungin or caspofungin for up to 4 weeks, assessing Day 30 mortality, mycological eradication, time to negative blood culture, mortality due to candidaemia/IC, safety, and pharmacokinetics. 

The results showed that of 294 STRIVE/ReSTORE patients, 113 were in the ICU at randomization (rezafungin n = 46; caspofungin n = 67). At baseline, ~30% in each group had impaired renal function and/or an Acute Physiologic Assessment and Chronic Health Evaluation II score ≥ 20 in 1 patient with neutropenic in the caspofungin group. Day 30 all-cause mortality was 34.8% for rezafungin vs 25.4% for caspofungin, while mycological eradication on Days 5 and 14 was 78.3% and 71.7% (rezafungin) vs 59.7% and 65.7% (caspofungin). The median time to negative blood culture was 18 (IQR, 12.6–43.0) vs. 38 (IQR, 15.9–211.3) hours (P = 0.001). About 2 patients were dead in rezafungin and 1 in caspofungin was attributed to candidaemia/IC, with similar safety profiles. Discontinuation due to adverse events (AEs) was 17.4% (rezafungin) vs 29.9% (caspofungin). Rezafungin exposure after the initial 400-mg dose was similar for ICU (n = 50) and non-ICU patients (n = 117). 

The study concluded that rezafungin is well tolerated and effective in critically ill, primarily non-neutropenic patients with candidaemia and/or invasive candidiasis. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05117-5