Repurposing the Antiviral Agent Pibrentasvir: In Vitro Synergistic Effects in Combination with Different Azole Antifungal Agents

Objective: To investigate the combined effects of multiple drugs and provide more therapeutic options for invasive fungal infections, this study evaluated the in vitro susceptibility of Aspergillus spp., Candida auris, Cryptococcus neoformans, and Exophiala dermatitidis to pibrentasvir (PIB) in combination with itraconazole (ITR), voriconazole (VOR), posaconazole (POS), or fluconazole (FLU). Methods: According to the M27-A3 and M38-A2 guidelines established by the Clinical and Laboratory Standards Institute (CLSI), the in vitro antifungal activities of PIB combined with ITR, VOR, POS, or FLU against 78 clinical isolates, including Aspergillus spp., E. dermatitidis, C. auris, and C. neoformans, were determined. The minimum inhibitory concentrations (MICs) and fractional inhibitory concentration indices (FICIs) were calculated to evaluate the synergistic effects. Results: PIB alone exhibited no antifungal activity. Significant synergistic effects were observed when PIB was combined with azole antifungal agents.