Rezafungin Versus Caspofungin in Candidaemia and Invasive Candidiasis: A Post Hoc Pooled Analysis of Phase 2 and Phase 3 Trials

Soriano, Alex;Thompson, George;Cornely, Oliver;Bassetti, Matteo;Pappas, Peter;et.al.
(2026) Mycoses — Vol. 69, n° 7, p. e70205 (2026)

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  • Soriano, AlexDepartment of Infectious Diseases, Hospital Clínic de Barcelona, IDIBAPS University of Barcelona, CIBERINF Barcelona Spain
    Author
  • Thompson, GeorgeDepartment of Internal Medicine, Division of Infectious Diseases University of California Davis Medical Center Sacramento California USA
    Author
  • Cornely, Oliverorcid-logoInstitute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD), Faculty of Medicine University of Cologne Cologne Germany
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  • Bassetti, MatteoUniversity of Genoa and Policlinico San Martino IRCCS Hospital Genoa Italy
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  • Honoré, PatrickUCLouvain
    Author
  • Pappas, Peterorcid-logoUniversity of Alabama at Birmingham Birmingham Alabama USA
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Abstract
Background: The efficacy and safety of rezafungin in invasive candidiasis (IC) and candidaemia was demonstrated in the Phase 2 STRIVE and Phase 3 ReSTORE trials, and an additional cohort of patients in ReSTORE from China (ReSTORE China). Objectives: This post hoc analysis is the first time that combined data from all double-blind, randomised Phase 2 and 3 rezafungin trials have been evaluated. Outcomes were comprehensively assessed across a large, diverse population. Methods: Data were assessed from adults with candidaemia/IC in STRIVE (NCT02734862) and ReSTORE (NCT03667690) (including the China extension cohort) who received weekly rezafungin 400/200 mg or daily caspofungin 70/50 mg for ≤ 4 weeks. Efficacy was assessed in the modified intent-to-treat population. Endpoints were Day 30 all-cause mortality (ACM, primary), mycological response at Days 5 and 14 (secondary) and time to negative blood cultures (TTNBC, secondary). Treatment-emergent adverse events were assessed in the safety population. Results: Overall, 372 patients were included (rezafungin 179; caspofungin 193). Day-30 ACM was 20% (33/161) for rezafungin versus 22% (39/178) for caspofungin (weighted difference, −2.4% [95% confidence interval −11.2 to 6.4]). Day-5 and Day-14 myco-logical eradication rates were 73% and 70% for rezafungin versus 65% and 68% for caspofungin, respectively. Median TTNBC was shorter for rezafungin than for caspofungin (23.1 versus 36.7 h, respectively; p = 0.0073). Adverse-event profiles were generally similar across treatments.
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Soriano, A., Thompson, G., Cornely, O., Bassetti, M., Kullberg, B., Honoré, P., Dupont, H., Vazquez, J., Huang, H., Zhang, Y., Dickerson, S., Cox, L., & Pappas, P. (2026). Rezafungin Versus Caspofungin in Candidaemia and Invasive Candidiasis: A Post Hoc Pooled Analysis of Phase 2 and Phase 3 Trials. Mycoses, 69(7), e70205. https://doi.org/10.1111/myc.70205 (Original work published 2026)