The world market for antifungal agents is currently in excess of US$6 billion with consistent annual growth. This market for systemic agents for serious infection is currently served by only three major drug classes, triazoles, polyenes and, echinocandins. Of these the azole class is dominant with voriconazole the market leading agent. The echinocandins are the latest class of agent to be introduced to the market but crude mortality remains high.

Increasing resistance is being seen amongst Candida and Apsergillus species particularly to azoles and this is thought to be driven by the use of azoles in agriculture.

The market for systemic antifungals is driven by year on year increases in the susceptible immune compromised patient population. Increases in cancer, organ transplants and use of potent drugs, including broad spectrum antibiotics has led to significant increases in fungal infections. Fungi are now recognised as a major issue in several respiratory conditions being responsible for exacerbations of symptoms in asthma, COPD and bronchiectasis patients. This will undoubtedly increase the use of antifungal drugs over the coming years.

Sales of both established agents and newly launched anti-fungals are significant with some in the “blockbuster” category. Amongst established agents, fluconazole and terbinafine had peak sales in excess of US$1bn. Peak sales of voriconazole (US$800M) itraconazole (US$900M) and caspofungin (US$600M) are also high whilst Ambisome has consistent sales of around US$400M.