18-22 September is Fungal Disease Awareness Week (FDAW) in the US, in which the Centers for Disease Control and Prevention (CDC) and its partners promote activities and outreach that encourage everyone to “Think Fungus”. The health burden of fungal disease is the focus of webinars and interactive events designed to encourage awareness and understanding. In a world in which media attention of infectious diseases is often dominated by viral and bacterial infections, the dangers of fungal diseases often go unnoticed. Therefore, FDAW provides a valuable opportunity to raise awareness, serving as a critical reminder of the often underestimated but significant impact of these infections.

Fungal diseases range from superficial infections, which are typically mild and primarily affect the skin, hair, or nails, to invasive fungal infections, which are systemic infections that result from the establishment of yeasts or moulds in deep-seated tissues and can be life-threatening. GlobalData estimates that there were over three million incident cases of invasive fungal infections across the 16 major pharmaceutical markets (16MM) (Australia, Brazil, Canada, China, France, Germany, India, Italy, Japan, Mexico, Russia, South Africa, South Korea, Spain, UK, and US) in 2022, of which aspergillosis, candidiasis, cryptococcosis, and pneumocystis pneumonia were major contributors. Incident cases of invasive fungal infections are also expected to escalate in the coming years, partially due to the impacts of climate change. With increasing global temperatures, fungi may expand their habitats to encompass new, warmer regions. For example, Cryptococcus deuterogattii has emerged in the temperate regions of western Canada and the Pacific Northwest of North America in recent years, and this is thought to be attributable to climate change.

Medical advances over recent decades have led to a global increase in the number of immunocompromised individuals such as organ transplant recipients or those living with HIV/AIDS, with these patients being much more susceptible to invasive fungal infections. Yet, despite the rising number of cases, the initial detection of fungal diseases is often inadequate, leading to misdiagnoses or delayed diagnoses that can cost lives.

Furthermore, the emergence of antifungal resistance has resulted in the inability to treat certain infections, which contributes to the high rates of morbidity and mortality associated with invasive fungal infections. As with antimicrobial resistance (AMR) in general, antifungal resistance is a burgeoning global health concern that jeopardises the effectiveness of existing treatment options. Most antifungal therapies can be divided into five distinct classes: azoles, echinocandins, polyenes, pyrimidine analogue flucytosine, and allylamines. The limited variability in therapeutic options means that treating fungal infections is challenging. In order to combat the growing resistance to existing drugs, it is essential that new therapeutic candidates utilize novel mechanisms of action in order to eradicate infections.

According to GlobalData, there are currently more than 170 antifungal agents in the pipeline. While many of these are based on established mechanisms of action, some utilise novel approaches, such as Pfizer’s fosmanogepix (a GPI-anchored wall transfer protein 1 inhibitor) in Phase II development for candidiasis and Phase I development for coccidioidomycosis, among others.

Therefore, FDAW highlights the impact of fungal diseases and stresses the urgent need to tackle antifungal resistance. It is hoped that advances with novel antifungal therapies in development will help to address the major unmet need of limited treatment options within this market.

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