FURI Study Case: Ibrexafungerp Successfully Treats Esophageal Candidiasis

Candida species are a common cause of mucosal and invasive candidiasis. In certain circumstances, patients may develop refractory candidiasis as a result of either resistance to antifungals or innate immune system deficiencies.

While conducting a study evaluating the safety and efficacy of ibrexafungerp (IBX, formerly SCY-078), investigators observed that a case of severe refractory esophageal candidiasis was treated successfully with the novel glucan synthase inhibitor antifungal.

Details on this case were presented in a poster presentation at the European Congress for Clinical Microbiology and Infectious Diseases (ECCMID 2019).

IBX has documented broad spectrum of activity against common species of Candida, Aspergillus, and Pneumocystis. The antifungal is being evaluated in an open-label clinical trial of patients either intolerant or refractory to antifungal therapy. The trial is called SCYNEXIS Study 301, or FURI.

At ECCMID 2019, Contagion® spoke to the presenter of the poster Jose Vazquez, MD, chief of infectious disease at Medical College of Georgia, who is also a member of the Contagion® Editorial Advisory Board.

One patient, a 63-year-old man with esophageal candidiasis that was refractory to fluconazole 200 mg/daily was enrolled into the trial. The patient had a history of esophageal strictures with recurrent esophageal candidiasis documented in the past 10 years.

Prior to enrollment, the patient experienced dysphagia, which escalated to the point that he was unable to swallow. As a result, a feeding tube was inserted. Additionally, an esophagogastroduodenoscopy demonstrated severe esophageal candidiasis throughout the esophagus with a culture revealing Candida glabrata resistant to fluconazole (MIC 64 mcg/ml).

The patient was enrolled into the trial and given a loading dose of oral IBX 750 mg twice a day for 2 days, followed by oral IBX 750 mg daily for a total of 54 days.

While receiving treatment, the patient gradually improved and by day 54 he was completely asymptomatic. No adverse events were reported during therapy.

One month following the discontinuation of therapy, the patient remained asymptomatic and was able to eat and drink without discomfort. A follow-up esophagogastroduodenoscopy did not detect any esophageal candidiasis and 2 months later the feeding tube was removed.

The patient was observed again at a 9 month follow-up and remained asymptomatic and was gaining weight.

“This report demonstrates the efficacy of IBX in a patient with severe recalcitrant and refractory [esophageal candidiasis], and highlights the potential for using IBX to manage difficult to treat azole resistant and refractory candidiasis,” the investigators concluded.

The study, “Use of ibrexafungerp (formerly SCY-078) to treat severe azole-refractory esophageal candidiasis: a case report from the FURI study,” was presented in a poster presentation on April 13, 2019, at ECCMID 2019 in Amsterdam, the Netherlands.