Abstract

Mortality from invasive aspergillosis remains unacceptably high, and the currently recommended treatment of triazoles is further challenged by rising resistance to these first-line agents. A previous randomised controlled trial of combination therapy with voriconazole plus anidulafungin versus voriconazole alone showed that the combination was safe and associated with a clinically significant reduction in all-cause mortality that, however, failed narrowly to meet conventional levels of significance. In this Personal View, we argue against a binary, negative interpretation of these results, and that the totality of the laboratory and clinical evidence favours a triazole–echinocandin combination for the treatment of immunocompromised patients with proven or probable invasive aspergillosis. Renewed efforts are needed to optimise and evaluate other combination approaches for aspergillosis and other life-threatening invasive fungal diseases as a means by which to mitigate antifungal resistance, maximise and prolong the utility of old and new agents, and drive down mortality.