Some newer azoles are still in development, but most only target candidiasis. Many years ago we saw development of nikkomycin (Nik Z), a drug mainly for coccidioidomycosis (Valley Fever). It has no appreciable activity against candida or aspergillus. Then there is ibrexafungerp, a promising new agent against C. albicans and C. auris but again without activity against aspergillus.
Aspergillus AND Candida coverage are critically important in immunocompromised patients. Aspergillus drugs in particular are needed nowadays to replace amphotericin B (AMB).
Here is a side-by-side tabulation of key features of newer antifungals. Below are some in-depth references. Highly anticipated are olorofim, which was discussed recently, and fosmanogepix, that has been moving forward rapidly and is also now in Phase 3.
Fosmanogepix is the new kid on the block. As a Gwt1 enzyme inhibitor, it introduces a novel MoA and has great activity against Candida and Aspergillus. It holds much promise and its path through clinical development will be the topic of an upcoming blog.
Stay tuned and come back for more!
ABBREVIATIONS
LD loading dose
RVVC recurrent vulvovaginal candidiasis
REFERENCES
Hoenigl M. Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease. Clin Microbiol Rev. 37 (2): 1, 2024
Johnson M. Current Antifungals and the Developing Pipeline. Infect Dis Clin N Am 39 (2025) e1
Kriegl L. New treatment options for critically important WHO fungal priority pathogens. Clinical Microbiology and Infection 31 (2025) 922
NOTE: Some name changes
Nakaseomyces glabrata formerly Candida glabrata
Candidozyma auris formerly Candida auris
