Compassionate Use of Olorofim for Invasive Mold Infections: A Nationwide Observational Study in France

Background The increasing incidence of resistant invasive mold infections (IMIs) has highlighted the need for novel antifungal agents. Olorofim, a first-in-class orotomide, has shown promising efficacy in a recent phase II study, but clinical data remain limited. Methods We conducted a retrospective multicenter cohort study in France, including all patients who received olorofim under compassionate use for proven or probable non-Mucorales IMIs. Eligible patients had IMIs refractory to or intolerance to standard antifungals, or no effective treatment options. Efficacy was defined as mycological and clinical control of infection; safety was also assessed. Results Between January 2020 and December 2023, 17 patients (median age: 39 years) received olorofim. Underlying conditions included primary immunodeficiency (n=4) and lung transplantation (n=5). Sites of infection included lung (88.2%), central nervous system (CNS) (23.5%), with 5 cases of disseminated disease. Twenty-three strains were identified, mostly Aspergillus fumigatus (34.8%) and Microascus spp. (13%). Median duration of prior antifungal therapy was 9.1 months. Olorofim was used primarily for refractory IMIs (70.6%) and in combination with other antifungals in 82.4% of cases. Olorofim minimum inhibitory concentrations (MICs) were ≤0.5 mg/L in the 8 available isolates. Among 15 evaluable patients, 5 (33.3%) achieved clinical and mycological success, 7 (46.7%) had partial responses, and 3 (20%) experienced treatment failure. Three-month mortality was 29.4% (n=5/17). No severe adverse events were reported. Conclusions Olorofim exhibited potential efficacy and good tolerability in patients with refractory IMIs. Further data from ongoing clinical trials are needed to confirm these findings.