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Isavuconazole in chronic pulmonary aspergillosis: What is the evidence?
Vitor Falcão de Oliveira1, Mariane Taborda2, Jéssica Toshie Katayose3
1Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Background:
Newer drugs like isavuconazole have been more widely used for invasive aspergillosis, where they are included as first-line treatments in major guidelines, whereas their use in chronic pulmonary aspergillosis (CPA) remains limited. Therefore, the aim of this study is to conduct a systematic review of the literature on the use of isavuconazole in CPA.
Methods:
We searched PubMed/MEDLINE and Embase on August 9th, 2024. Our inclusion criteria included patients with CPA who were treated with isavuconazole. We summarized binary variables with counts and percentages, and continuous variables with mean and SD.
Results:
We found 15 articles on CPA using isavuconazole. These studies were published after 2017, with a high predominance in high-income countries, especially US (40 %, n = 6) and UK (33.3 %, n = 5). There were 10 case reports, the majority of which used isavuconazole as salvage therapy. Two articles compared isavuconazole with voriconazole. The overall response rates at the end of treatment for CPA patients were similar, and the incidence of adverse drug reactions was numerically lower in the isavuconazole group compared to voriconazole. We found five articles on blood levels of isavuconazole. The mean isavuconazole serum level was >1 mg/L in all studies, even at a 100-mg daily dose. In the retrospective studies, the rate of isavuconazole discontinuation ranged from 17 % to 36 %.
Conclusion:
There is limited experience with isavuconazole in treating CPA. This study consolidates existing evidence on its use in CPA, highlighting its potential as a therapeutic option beyond invasive aspergillosis, though further research is needed.
Insights
This review of isavuconazole for chronic pulmonary aspergillosis (CPA) found limited data but suggests potential efficacy. Isavuconazole showed comparable response rates and fewer adverse events than voriconazole in CPA patients.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pharmacology
Background:
- Isavuconazole is a first-line treatment for invasive aspergillosis.
- Its use in chronic pulmonary aspergillosis (CPA) is less established.
- Limited data necessitates a review of isavuconazole's role in CPA.
Purpose of the Study:
- To systematically review the literature on isavuconazole use in CPA.
- To consolidate current evidence on isavuconazole for CPA treatment.
Main Methods:
- Systematic literature search of PubMed/MEDLINE and Embase.
- Inclusion criteria: CPA patients treated with isavuconazole.
- Data summarized using counts, percentages, mean, and standard deviation.
Main Results:
- 15 articles published post-2017 were identified, predominantly from high-income countries.
- Isavuconazole was often used as salvage therapy; response rates were similar to voriconazole.
- Adverse drug reactions were numerically lower with isavuconazole; mean serum levels exceeded 1 mg/L.
Conclusions:
- Experience with isavuconazole in CPA is limited but promising.
- Isavuconazole may be a viable therapeutic option for CPA.
- Further research is required to fully establish its role in CPA management.
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