Ibrexafungerp, sold under the brand name Brexafemme, is an antifungal medication used to treat vulvovaginal candidiasis (VVC) (vaginal yeast infection). It is taken by mouth. An estimated 75% of women will have at least one episode and 40 to 45% will have two or more episodes in their lifetime.Ibrexafungerp is a triterpenoid antifungal. It acts via inhibition of glucan synthase, which prevents formation of the fungal cell wall.Ibrexafungerp was approved for medical use in the United States in June 2021. It is the first approved drug in a novel antifungal class. Medical uses
Ibrexafungerp is indicated for the treatment of adult and postmenarchal pediatric females with vulvovaginal candidiasis (VVC). Pharmacology
Pharmacodynamics
Ibrexafungerp is a triterpenoid antifungal agent. It acts via inhibition of the enzyme glucan synthase, which is involved in the formation of 1,3-β-D-glucan—an essential component of the fungal cell wall. The compound has concentration-dependent fungicidal activity against Candida species. Pharmacokinetics
Ibrexafungerp has a time to maximal concentrations of 4 to 6 hours. It is metabolized by hydroxylation via CYP3A4 and subsequently by glucuronidation and sulfation. The medication has an elimination half-life of approximately 20 hours. References
Further reading
Azie N, Angulo D, Dehn B, Sobel JD (September 2020). "Oral Ibrexafungerp: an investigational agent for the treatment of vulvovaginal candidiasis". Expert Opin Investig Drugs. 29 (9): 893–900. doi:10.1080/13543784.2020.1791820. PMID 32746636. Davis MR, Donnelley MA, Thompson GR (July 2020). "Ibrexafungerp: A novel oral glucan synthase inhibitor". Med Mycol. 58 (5): 579–592. doi:10.1093/mmy/myz083. PMID 31342066. Petraitis V, Petraitiene R, Katragkou A, Maung BB, Naing E, Kavaliauskas P,  et al. (May 2020).
This is the general strategy used for designing exon-skipping oligos for DMD; as there are 79 exons transcribed in the longest splice form of the dystrophin transcript, many different oligos are needed to address the range of mutations present in the population of people with DMD.Eteplirsen is a morpholino antisense oligomer which triggers excision of exon 51 during pre-mRNA splicing of the dystrophin RNA transcript. Skipping exon 51 changes the downstream reading frame of dystrophin; giving eteplirsen to a healthy person would result in production of dystrophin mRNA which would not code for functional dystrophin protein but, for DMD patients with particular nonsense mutations, giving eteplirsen can restore the reading frame of the dystrophin mRNA and result in production of functional (although modified by having an internal deletion consisting of both the patients original defect, as well as the therapeutically skipped exon) dystrophin. Eteplirsen is given by intravenous infusion for systemic treatment of DMD. Exon skipping is induced by eteplirsen, a charge-neutral, phosphorodiamidate morpholino oligomer (PMO) that selectively binds to exon 51 of dystrophin pre-mRNA, restoring the phase of the reading frame and enabling production of functional, but internally edited, dystrophin. The uncharged nature of the PMO helps make it resistant to biological degradation. This modified dystrophin protein produced by eteplirsen may cause a less severe form of dystrophinopathy, much like Becker muscular dystrophy. Eteplirsens proposed mechanism of action is to bind to dystrophin pre-mRNA and alter the exon splicing of the RNA so that more almost full-length dystrophin is made.