Successful outpatient parenteral antimicrobial therapy with rezafungin for chronic pulmonary aspergillosis: a case report and health economic assessment.

BACKGROUND

Chronic pulmonary aspergillosis (CPA) is a serious lung disorder caused by Aspergillus fungal infection with high morbidity and mortality. Treatment options include antifungal azoles, polyenes and echinocandins. Rezafungin is a novel, once-weekly echinocandin that may benefit CPA management in outpatient parenteral antimicrobial therapy (OPAT) services.

OBJECTIVES

To report a case where rezafungin was potentially effective in managing CPA for a patient with limited treatment options, and to estimate the health economic impact of rezafungin versus once-daily echinocandin in an OPAT setting.

PATIENTS AND

METHODS

We discuss a patient with CPA, diagnosed in 2020, with frequent episodes of haemoptysis, dyspnoea, productive cough and lethargy with progressive bilateral pulmonary cavitatory lesions and nodules treated with rezafungin over 12 weeks via OPAT. Costs to deliver once-weekly rezafungin compared with once-daily caspofungin in the OPAT clinic were compared.

RESULTS

Symptoms improved significantly after 12 weeks of rezafungin, with no further emergency visits, versus eight in the year prior due to CPA symptoms. Aspergillus serology (IgG) improved and computerized tomography imaging showed slight improvement in the degree of consolidation surrounding the cavities. Daily OPAT costs increased by £13.71 for rezafungin compared with caspofungin. This was offset by greater patient convenience and improved OPAT clinic capacity.

CONCLUSIONS

Rezafungin may be a novel, well-tolerated and cost-effective echinocandin treatment for CPA in patients needing OPAT and with limited treatment options. Further clinical studies are required for robust evaluation of this novel echinocandin in CPA.