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Published on: March 9, 2018
Experience with isavuconazole in lung transplant recipients with Aspergillus isolation in respiratory tract
Jose Tiago Silva1,2, Francisco López-Medrano1,2, Alicia de Pablo3
1Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.
Background:
Aspergillus is a life-threatening opportunistic pathogen in lung transplant recipients (LuTRs). Isavuconazole (ISA) is a broad-spectrum triazole with favorable pharmacokinetics and safety profile. The clinical experience with ISA in LuTRs, however, is still limited.
Methods:
We performed an ambispective observational study from June 2019 to June 2024 in 5 Spanish centers. Adult LuTRs with isolation of Aspergillus spp. in respiratory tract specimens and indication of ISA therapy (either for the treatment of invasive pulmonary aspergillosis [IPA] or tracheobronchial aspergillosis [TBA] or for preemptive therapy) were eligible. The safety outcome comprised the occurrence of treatment-emergent adverse events (trAEs) and the need for modification of tacrolimus dose. Effectiveness outcomes included clinical, mycological, and radiological response at the end of treatment (EoT).
Results:
Overall, 50 LuTRs were included. ISA was administered for a median duration of 101 days (interquartile range: 27-161) for the treatment of IPA (18 [36.0%]) or TBA (27 [54.0%]) and as preemptive therapy (5 [10.0%]). The incidence rates of any trAE and trAE requiring premature ISA discontinuation were 24.0% and 10.0%, respectively. Most patients (35 [70.0%]) completed the planned course of therapy. Tacrolimus daily dose was reduced by a median of one-third in half of the patients (26/48 [54.2%]). Clinical, mycological, and radiological responses at EoT among were achieved in 66.7%, 84.2%, and 64.3% of evaluable patients, respectively. Aspergillosis-attributable mortality at the end of follow-up was 12.0%.
Conclusions:
ISA was well tolerated in LuTRs and proved to be effective for the treatment of invasive Aspergillus syndromes.
Insights
Isavuconazole (ISA) is safe and effective for treating invasive Aspergillus syndromes in lung transplant recipients (LuTRs). This study shows good clinical, mycological, and radiological responses with low adverse events in LuTRs receiving ISA.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Transplantation Medicine
Background:
- Aspergillus is a dangerous opportunistic pathogen in lung transplant recipients (LuTRs).
- Isavuconazole (ISA) is a broad-spectrum triazole antifungal with a good safety profile.
- Limited clinical data exists on ISA use in LuTRs.
Purpose of the Study:
- To evaluate the safety and effectiveness of Isavuconazole (ISA) in lung transplant recipients (LuTRs).
- To assess ISA's role in treating invasive pulmonary aspergillosis (IPA), tracheobronchial aspergillosis (TBA), and for preemptive therapy in LuTRs.
Main Methods:
- An ambispective observational study was conducted across 5 Spanish centers from June 2019 to June 2024.
- Included adult LuTRs with Aspergillus spp. isolation and ISA therapy indication.
- Safety outcomes included treatment-emergent adverse events (trAEs) and tacrolimus dose adjustments. Effectiveness outcomes assessed clinical, mycological, and radiological responses.
Main Results:
- 50 LuTRs received ISA for a median of 101 days for IPA, TBA, or preemptive therapy.
- The incidence of any trAE was 24.0%, with 10.0% requiring premature discontinuation.
- Clinical, mycological, and radiological responses were observed in 66.7%, 84.2%, and 64.3% of evaluable patients, respectively. Aspergillosis-attributable mortality was 12.0%.
Conclusions:
- Isavuconazole (ISA) demonstrated good tolerability in lung transplant recipients (LuTRs).
- ISA proved effective in treating invasive Aspergillus syndromes in this LuTR population.
- The findings support ISA as a viable treatment option for Aspergillus infections post-lung transplantation.
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