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Q&A: What’s in the antifungal pipeline?
Researchers writing in Open Forum Infectious Diseases recently provided a snapshot of the antifungal pipeline, which includes some drugs with novel mechanisms of action to overcome resistance.
Infectious Disease News asked Andrej Spec, MD, MSCI, assistant professor of infectious diseases and associate director of the infectious disease clinical research unit at Washington University School of Medicine in St. Louis, when physicians can expect to have access to some of these drugs. – by Gerard Gallagher
Q: What makes treating invasive fungal infections so challenging?
A: Compared to bacteria and viruses, fungi are significantly more closely related to us and have a lot of the same basic cellular machinery. As a result, finding compounds that are deleterious to fungi, but not to humans, is harder than for bacteria. In addition, fungi, while causing significant morbidity and mortality, are perceived as causing “rare diseases,” which makes the pathway to commercializing a new medication harder. However, there are hundreds of thousands of people every year who die of fungal diseases, and it is important to note that this might be a situation of “If you build it, they will come.”
Q: What inspired the review?
A: I was asked to comment on how I treat resistant fungi by a popular ID quiz platform on Twitter, WuidQ: Washington University ID Questions (@WUIDQ). Through my handle (@FungalDoc), I wrote a thread reply with the new drugs that might expand our armamentarium. The tweets became popular, and Paul Sax, MD, the Editor in Chief of Open Forum Infectious Diseases, thought this would be an important addition to the literature, with a goal to provide clinicians looking for salvage therapy with options. I was then lucky to be joined by Adriana Rauseo, MD (@arauseomd), one of our extraordinary fellows, and Ariella Coler-Reilly (@AriellaStudies), a medical student at our university and illustrator extraordinaire.
Q: What’s in the pipeline?
A: There are 15 compounds that were discussed in this review. Many include new mechanisms of action and many others provide coverage for fungal infections that currently have absolutely no therapy, such as pan-resistant Candida auris, Scopulariopsis brumptii and Lomentospora (previously Scedosporium) prolificans. Our review goes into detail about all the compounds and their innovations.
Q: When will doctors have access to these antifungals?
A: For the purpose of “salvage,” most are available now through trials and compassionate use. All patients who have fungal infections where the therapy is failing should be able to get access to therapies through salvage trials. These compounds are available at our site and at several others. As for commercial use of these compounds, a few are likely to be available in the next 2 to 3 years, but many are 5 to 10 years away from being sold in pharmacies.
Q: Have any shown efficacy against C. auris?
A: Many of these compounds are active against C. auris. As scary as the pan-resistant C. auris is, any patient who is infected with it should be able to get access to at least one of these drugs through a clinical trial if they are in the right center or are able to obtain a transfer there.
Reference:
Rauseo AM, et al. Open Forum Infect Dis. 2019;doi:10.1093/ofid/ofaa016.
Disclosure: Spec reports receiving consulting fees from Minnetronix, Scynexis and Viamet and an investigator sponsored grant from Astellas.