Role of isavuconazole in the treatment of invasive fungal infections.
Abstract
Despite recent advances in both diagnosis and prevention, the incidence of invasive
fungal infections continues to rise. Available antifungal agents to treat invasive
fungal infections include polyenes, triazoles, and echinocandins. Unfortunately, individual
agents within each class may be limited by spectrum of activity, resistance, lack
of oral formulations, significant adverse event profiles, substantial drug-drug interactions,
and/or variable pharmacokinetic profiles. Isavuconazole, a second-generation triazole,
was approved by the US Food and Drug Administration in March 2015 and the European
Medicines Agency in July 2015 for the treatment of adults with invasive aspergillosis
(IA) or mucormycosis. Similar to amphotericin B and posaconazole, isavuconazole exhibits
a broad spectrum of in vitro activity against yeasts, dimorphic fungi, and molds.
Isavuconazole is available in both oral and intravenous formulations, exhibits a favorable
safety profile (notably the absence of QTc prolongation), and reduced drug-drug interactions
(relative to voriconazole). Phase 3 studies have evaluated the efficacy of isavuconazole
in the management of IA, mucormycosis, and invasive candidiasis. Based on the results
of these studies, isavuconazole appears to be a viable treatment option for patients
with IA as well as those patients with mucormycosis who are not able to tolerate or
fail amphotericin B or posaconazole therapy. In contrast, evidence of isavuconazole
for invasive candidiasis (relative to comparator agents such as echinocandins) is
not as robust. Therefore, isavuconazole use for invasive candidiasis may initially
be reserved as a step-down oral option in those patients who cannot receive other
azoles due to tolerability or spectrum of activity limitations. Post-marketing surveillance
of isavuconazole will be important to better understand the safety and efficacy of
this agent, as well as to better define the need for isavuconazole serum concentration
monitoring.
Type
Journal articlePermalink
https://hdl.handle.net/10161/13075Published Version (Please cite this version)
10.2147/TCRM.S90335Publication Info
Wilson, Dustin T; Dimondi, V Paul; Johnson, Steven W; Jones, Travis M; & Drew, Richard
H (2016). Role of isavuconazole in the treatment of invasive fungal infections. Ther Clin Risk Manag, 12. pp. 1197-1206. 10.2147/TCRM.S90335. Retrieved from https://hdl.handle.net/10161/13075.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Richard Howard Drew
Professor in Medicine
Pharmacokinetics/pharmacodynamics of antimicrobials, antifungal use in compromised
hosts, antimicrobial stewardship, prediction and therapy of multidrug-resistant pathogens,
aerosolized antimicrobials

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