Vulvovaginal candidiasis has been treated with azole antifungals for decades, and resistance plus non-albicans species have eroded their reliability. Brexafemme (ibrexafungerp) introduced the first oral alternative outside that class.
Ibrexafungerp is a triterpenoid that inhibits fungal glucan synthase, disrupting cell wall synthesis through a target the azoles do not touch. Taken as a single-day, two-dose oral course, it treats vulvovaginal candidiasis in adult and postmenarchal pediatric females, and later gained an indication for reducing recurrence.
Commercial responsibility for Brexafemme has shifted through licensing since launch, but its mechanism remains the only oral non-azole option in the indication. It is the key comparator for antifungal programs targeting azole-resistant and non-albicans Candida.
