Monthly Ibrexafungerp for Repeat Yeast Infections: CANDLE Results

Check availability before planning a course

The October 14, 2026 ASHP shortage bulletin lists Brexafemme, the ibrexafungerp brand, as temporarily unavailable, with no estimated return date. Have a pharmacist check current supply before building a treatment plan around it.¹

CANDLE studied maintenance after initial improvement

The SCYNEXIS-sponsored CANDLE trial required a history of at least three yeast-infection episodes in 12 months, a confirmed current episode and improvement after initial treatment. Participants received three fluconazole doses, 72 hours apart, before entering the randomized maintenance phase.²

Maintenance compared ibrexafungerp 300 mg twice on one day, every four weeks for six treatment days, with matching placebo. This was not a comparison against continuing weekly fluconazole, and selecting initial responders limits what it tells us about infections that do not improve with fluconazole.²

Two recurrence measures gave different percentages

The 2025 CANDLE report randomized 130 participants per group. By week 24, 70.8% with ibrexafungerp versus 58.5% with placebo had no mycologically proven recurrence. The broader clinical-success outcome was 65.4% versus 53.1%; it required a week-24 evaluation and no proven, presumed or suspected recurrence.³

Thus, the larger percentage should not be read as “no further yeast-like symptoms.” At week 36, clinical success was 57.7% versus 46.2%. These were follow-up results, not proof of permanent prevention. Treatment-related adverse events occurred in 14.6% versus 6.9%.³

Pregnancy precautions extend beyond each treatment day

The July 2026 U.S. label contraindicates use during pregnancy. For people who can become pregnant, it requires checking pregnancy status before starting and recommends reassessment before each monthly dose. Effective contraception continues throughout the six-month prevention course and for four days after the last dose.⁴

A prescriber must also check interacting medicines, particularly strong CYP3A inhibitors and moderate or strong inducers. The label’s recurrent-infection study population averaged 34 years, with 95% younger than 50; that limits age-specific conclusions for women after menopause.⁴

Bring the dates of confirmed episodes, culture results, treatments used and what changed afterward. Ask which prevention option fits your test results, medicines and pregnancy plans, and what to do if symptoms return while supply remains unavailable.

“The Sorter” in Down There, Decoded puts recurring symptoms in the clinician-assessment category and uses the symptom log to prepare that visit. Our repeat-yeast guide covers the diagnostic discussion before choosing maintenance treatment.