First fungicidal medication for VVC approved by the FDA

Michael Krychman, MD, is a sexual health specialist and expert in survivorship medicine at the Southern California Center for Sexual Health and Survivorship Medicine.

Barb Dehn, NP, is a women’s health nurse practitioner at El Camino Women’s Group and a nationally recognized health expert who specializes in pregnancy, breastfeeding, fertility, menopause, and sexual health.

The following interview was conducted at the North American Menopause Society 2021 Annual Meeting from Sept. 22-25 in Washington, D.C.

MK: I wanted to talk to Nurse Barb about one of the exciting opportunities to learn more about [vulvovaginal candidiasis (VVC)]. This has really been a stagnant field for a very long time, and I know there's a new medication that just came out. You're the go-to gal for what's new and exciting, so tell us more about what's new in a humdrum, older condition that we haven't really thought about much.

BD: So VVC, vulvovaginal candidiasis. You and I both know, it's not just a yeast infection. Now, we may see this day in and day out. But for women, they're really suffering and there's a lot of impact. For the first time, though, we have a fungicidal medication, not fungistatic, which all the -azoles are. anything that ends in -azole is fungistatic, not fungicidal. Most clinicians are really surprised to learn that. So Brexafemme was just approved by the FDA. The generic name is ibrexafungerp. It's a fungicidal medication with excellent efficacy at 10 days, but also sustained efficacy at 25 days.

MK: I've looked at the data, and I'm really excited about this 9-to-1 tissue penetration. Any thoughts about that?

BD: Yes, that's amazing, isn't it? So with all of the -azoles, the tissue penetration is about the same as what you have in serum, so it's 1 to 1, but with Brexafemme, there's 9 times as much Brexafemme in the vaginal tissue as there is in serum. Also, and this is probably going to interest you, it works on a lower pH at less than 4.5. So that's really helpful for us. It also has a longer half-life of 20 hours. We don't know, but maybe that's why it has sustained efficacy.