Real-life experience on the use of isavuconazole in solid organ transplantation

Solid organ transplant (SOT) recipients have a higher risk of developing invasive fungal infection (IFI). Isavuconazole is a novel broad-spectrum azole active against Aspergillus and Mucor. Isavuconazole is well tolerated, shows an excellent bioavailability and predictable pharmacokinetics, good diffusion to tissues, significantly reduced drug-drug interactions with immunosuppressive drugs in comparison with other broad-spectrum azoles, and few serious adverse effects, including hepatic toxicity. We have performed an extensive literature review concerning the clinical experience on the use of isavuconazole in SOT as prophylaxis and treatment of IFI, which included the SOTIS and the ISASOT studies, and fourteen published case reports. Clinical response, all-cause and invasive aspergillosis-attributable mortality in recipients treated with isavuconazole were similar to those described with voriconazole. Drug-drug interactions with immunosuppressive agents were manageable after the adjustment of tacrolimus and mTOR inhibitors. Isavuconazole showed fewer drug-related side effects and a smaller rate of premature discontinuation than voriconazole. In conclusion, isavuconazole appears to be a reasonable option for the treatment of IFI in SOT, and can be an alternative to voriconazole as antifungal prophylaxis in lung transplantation. Nonetheless, more clinical studies are needed.