Document Type : Reviews
Authors
1
Department of Infectious Disease, Faculty of Medicine, Guilan University of Medical Science, Rasht, Iran
2
Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
3
Department of Medical Mycology and Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
4
Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
5
Department of Pulmonology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
10.22034/cmm.2026.345519.1746
Abstract
Background and Purpose: Recent advancements in biomedical science have introduced advanced triazole agents for the targeted treatment of pulmonary diseases, including various respiratory fungal infections. Opelconazole (PC945) is an innovative triazole-based antifungal compound that functions as a potent inhibitor of the CYP51 enzyme. It is strategically engineered for inhalation administration to achieve elevated local concentrations within the lungs while minimizing systemic exposure. In vitro studies have demonstrated the exceptional antifungal potency of opelconazole against various fungal strains, including antifungal drug-resistant fungal species. Furthermore, in vivo experiments using murine models of invasive pulmonary aspergillosis and candidiasis have revealed the superior efficacy of inhaled opelconazole, compared to conventional systemic antifungal therapies.
Materials and Methods: A systematic search was conducted in ScienceDirect, ClinicalTrials.gov, PubMed, and Scopus for studies published up to May 2025 using the terms "opelconazole" OR "PC945" OR "Pulmocide" OR "inhaled opelconazole". Inclusion criteria were studies reporting on opelconazole for human pulmonary fungal infections with clinical or mycological outcomes. Study selection, data extraction, and synthesis were conducted in accordance with the PRISMA guidelines.
Results: Among 141 identified records, 10 studies met the inclusion criteria. Most studies focused on invasive aspergillosis. Based on the findings, inhaled opelconazole demonstrated favorable efficacy, reducing fungal burden and improving clinical outcomes, with a generally good safety profile and minimal adverse events.
Conclusion: Inhaled opelconazole is a promising, well-tolerated option for pulmonary fungal infections, including those resistant to conventional therapy. According to the study results, this agent could be an effective treatment option for patients who do not respond to or cannot tolerate other treatments. However, larger randomized controlled trials are needed to confirm these results.
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