Why is rezafungin given only once a week?

A structural modification gives it a long half-life and high stability, so a weekly infusion maintains effective exposure.

How does rezafungin differ from older echinocandins?

It shares the same beta-1,3-glucan synthase mechanism but is engineered for a much longer duration of action, allowing once-weekly rather than daily dosing.

Was rezafungin as effective as existing treatment in trials?

In the phase 3 ReSTORE trial it was non-inferior to daily caspofungin, a standard echinocandin.

Is rezafungin taken as a pill?

No; it is given as an intravenous infusion in a healthcare setting, not orally.

EMA-approvedaka Rezzayo, CD101

Rezafungin — Complete Research Guide (2026)

Last updated 2026-06-30

TL;DR

Rezafungin (also known as Rezzayo) is a peptide catalogued under Cyclic & Antimicrobial (Long-acting echinocandin). It is described as: β-1,3-glucan synthase. Documented context: Candidemia. Neutral reference entry; EU status: EU-approved prescription medicine.

What is Rezafungin?

Rezafungin (brand name Rezzayo) is a next-generation, long-acting echinocandin structurally derived from anidulafungin, given intravenously once weekly.

It received FDA approval in 2023 and EU approval for the treatment of candidaemia and invasive candidiasis in adults with limited treatment options.

Evidence level is high: approval was based on the phase 2 STRIVE and phase 3 ReSTORE randomised controlled trials in humans.

How does Rezafungin work?

Like other echinocandins, rezafungin inhibits beta-1,3-glucan synthase to block fungal cell-wall glucan synthesis.

A structural modification confers metabolic and chemical stability that gives it a long half-life, enabling once-weekly dosing with high front-loaded exposure.

What does the research say about Rezafungin?

In the phase 3 ReSTORE trial, once-weekly rezafungin was non-inferior to daily caspofungin for candidaemia and invasive candidiasis. ^[1]
Pooled data from the STRIVE and ReSTORE randomised trials confirmed efficacy and safety comparable to caspofungin. ^[3]
Outcomes were consistent across the major infecting Candida species in the ReSTORE phase 3 analysis. ^[4]

Clinical research & studies

The references below are the primary sources cited throughout this guide. Each links directly to PubMed or the regulator. Where evidence is preclinical (animal or in-vitro), that is stated rather than implied.

[1] Rezafungin versus caspofungin for treatment of candidaemia and invasive candidiasis (ReSTORE): a multicentre, double-blind, double-dummy, randomised phase 3 trial — Thompson GR 3rd et al., Lancet 2023. (Randomized controlled trial (phase 3))
[2] Rezafungin Versus Caspofungin in a Phase 2, Randomized, Double-blind Study for the Treatment of Candidemia and Invasive Candidiasis: The STRIVE Trial — Thompson GR 3rd et al., Clinical Infectious Diseases 2021. (Randomized controlled trial (phase 2))
[3] Efficacy and safety of rezafungin and caspofungin in candidaemia and invasive candidiasis: pooled data from two prospective randomised controlled trials — Thompson GR 3rd et al., Lancet Infectious Diseases 2024. (Pooled analysis of RCTs)
[4] Outcomes by Candida spp. in the ReSTORE Phase 3 trial of rezafungin versus caspofungin for candidemia and/or invasive candidiasis — Locke JB et al., Antimicrobial Agents and Chemotherapy 2024. (RCT secondary analysis)
[5] Rezafungin versus caspofungin for patients with candidaemia or invasive candidiasis in the intensive care unit: pooled analyses of the ReSTORE and STRIVE randomised trials — Honore PM et al., Critical Care 2024. (Pooled RCT analysis)
[6] The Antifungal Pipeline: Fosmanogepix, Ibrexafungerp, Olorofim, Opelconazole, and Rezafungin — Hoenigl M et al., Drugs 2021. (Review)

Dosing context

This is not medical advice or a usage recommendation. Dosing figures are reported research context only, cited from the published literature.

In the trials rezafungin was given as a higher intravenous loading dose in week one followed by once-weekly maintenance infusions.

This is provided as context only and not as a dosing recommendation; the treating clinician determines the appropriate regimen.

Side effects & safety profile

In controlled trials rezafungin had a safety profile broadly comparable to caspofungin, with common events including infusion-related reactions, gastrointestinal symptoms, pyrexia and transient liver enzyme elevations; photosensitivity was also reported.

As with the echinocandin class it is generally well tolerated, and its long half-life means exposure persists for some time after each dose.

This is educational information only; rezafungin is a hospital-administered prescription medicine that must be used under specialist supervision.

Stacking & combinations

Rezafungin is a prescription-only intravenous antifungal, not a supplement or peptide, and is not intended for self-directed combination or stacking.

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Frequently asked questions

It is approved for candidaemia and invasive candidiasis in adults, particularly those with limited alternative treatment options.

References

[1] Rezafungin versus caspofungin for treatment of candidaemia and invasive candidiasis (ReSTORE): a multicentre, double-blind, double-dummy, randomised phase 3 trial — Thompson GR 3rd et al., Lancet 2023. PMID: 36442484. View sourceStudy: Randomized controlled trial (phase 3)Once-weekly rezafungin was non-inferior to daily caspofungin for candidaemia and invasive candidiasis.
[2] Rezafungin Versus Caspofungin in a Phase 2, Randomized, Double-blind Study for the Treatment of Candidemia and Invasive Candidiasis: The STRIVE Trial — Thompson GR 3rd et al., Clinical Infectious Diseases 2021. PMID: 32955088. View sourceStudy: Randomized controlled trial (phase 2)Rezafungin showed efficacy and tolerability comparable to caspofungin, supporting once-weekly dosing.
[3] Efficacy and safety of rezafungin and caspofungin in candidaemia and invasive candidiasis: pooled data from two prospective randomised controlled trials — Thompson GR 3rd et al., Lancet Infectious Diseases 2024. PMID: 38008099. View sourceStudy: Pooled analysis of RCTsPooled STRIVE and ReSTORE data confirmed comparable efficacy and safety versus caspofungin.
[4] Outcomes by Candida spp. in the ReSTORE Phase 3 trial of rezafungin versus caspofungin for candidemia and/or invasive candidiasis — Locke JB et al., Antimicrobial Agents and Chemotherapy 2024. PMID: 38526046. View sourceStudy: RCT secondary analysisEfficacy of rezafungin was consistent across the major Candida species.
[5] Rezafungin versus caspofungin for patients with candidaemia or invasive candidiasis in the intensive care unit: pooled analyses of the ReSTORE and STRIVE randomised trials — Honore PM et al., Critical Care 2024. PMID: 39468640. View sourceStudy: Pooled RCT analysisRezafungin performed comparably to caspofungin in critically ill ICU patients.
[6] The Antifungal Pipeline: Fosmanogepix, Ibrexafungerp, Olorofim, Opelconazole, and Rezafungin — Hoenigl M et al., Drugs 2021. PMID: 34626339. View sourceStudy: ReviewPositions rezafungin among emerging antifungals and summarises its long-acting once-weekly profile.

This article is for educational and research purposes only. Peptides discussed here are not approved for human consumption by the FDA, EMA, or equivalent regulators outside of specific clinical contexts. Always consult a licensed medical professional before any therapeutic use.