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Salvage Therapy for the Treatment of Mucormycosis

  • Transplant/Immunocompromised Hosts (M Morales, Section Editor)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose of Review

We aim to discuss the evidence behind combination therapy as well as to describe the novel antifungals used in the treatment for mucormycosis.

Recent Findings

In patients with advanced or refractory invasive mucormycosis, limited data support the use of combination salvage therapy with a polyene backbone plus an echinocandin. Several new antifungal agents have also shown in vitro activity against Mucorales by acting through different mechanisms. VT1161 and VT-1598 are next-generation azoles, termed tetrazoles, that target the fungal cell membrane by inhibiting the CYP51 enzyme with minimal drug-drug interactions. Fosmanogepix (APX001) is a glycosylphosphatidylinositol inhibitor with a broad spectrum of activity. Finally, MGCD290 is a histone deacetylase inhibitor that has shown synergistic effects with azoles and echinocandins.

Summary

Mucormycosis is a life-threatening disease. Current guidelines recommend polyenes and certain azoles as first-line treatment along with surgical management and correction of specific host factors. For refractory mucormycosis, there are combination salvage therapy options with evidence from murine models and human case reports; however, there have been no prospective, randomized clinical trials to prove their efficacy. For those intolerant of polyenes and azoles, there are novel drug therapies that have shown in vitro activity against Mucorales, although further investigation is needed to determine if these agents should be used clinically as monotherapy or in combination with existing agents.

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Authors and Affiliations

  1. University of Maryland Medical Center, 22 S. Greene St., Baltimore, MD, 21201, USA

    Ashka A. Patel DO

  2. University of Maryland School of Medicine, Baltimore, MD, USA

    Jacqueline T. Bork MD & David J. Riedel MD, MPH

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Ashka A. Patel declares that she has no conflict of interest. Jacqueline T. Bork declares that she has no conflict of interest. David J. Riedel declares that he has no conflict of interest.

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Patel, A.A., Bork, J.T. & Riedel, D.J. Salvage Therapy for the Treatment of Mucormycosis. Curr Treat Options Infect Dis 13, 111–122 (2021). https://doi.org/10.1007/s40506-021-00250-z

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