Isavuconazole Comparable to Other Antifungals in Treating Invasive Fungal Infections

The novel triazole antifungal agent, isavuconazole, was found to be comparable to other antifungals for the treatment and prevention of invasive fungal infections (IFIs), and is associated with fewer drug-related adverse events and discontinuations, according to a study published in Mycoses.

Researchers conducted a systematic review and meta-analysis of studies that included patients who received isavuconazole and other antifungal agents to assess the efficacy and safety of the drug for the treatment of IFIs.

Following PRISMA guidelines, the authors searched Scopus, EMBASE, PubMed, CINAHL, and Ichushi for articles in English and Japanese published up to February 7, 2023. Eligible studies were randomized controlled trials and retrospective and cohort studies that reported mortality, IFI rate, discontinuation rate due to adverse events, or incidence of abnormal hepatic function in patients with IFIs treated with and without isavuconazole.

The primary outcomes were overall mortality for treatment and IFI rate for prophylaxis. A control group included patients treated with antifungal agents other than isavuconazole.

The analysis included 10 studies, 2 of which were randomized control trials. Control group patients received amphotericin B, voriconazole, and posaconazole for IFIs.

In 6 studies with 870 participants that evaluated mortality for treatment of IFIs, pooled analysis showed no significant decrease in mortality in the isavuconazole group vs the control group in a fixed-effects model (treatment, odds ratio [OR] 1.11; 95% CI, 0.82-1.51; I²=0%). The mortality rate was lower among patients in the isavuconazole group (28.3%) compared with those in the control group (33.6%).

In a pooled analysis of 2 studies with 577 patients, the effects of isavuconazole for prophylaxis were found to be comparable to those of with the control groups in terms of the IFI rate (OR, 1.02; 95% CI, 0.49-2.12; I²=0%).

Regarding discontinuation rates, 5 studies with 387 participants receiving isavuconazole and 390 patients in the control group receiving other antifungal agents showed discontinuation rates of 9.8% and 16.9%, respectively, in the 2 groups. Patients in the control group had a significant decrease in the continued treatment rate compared with those of the isavuconazole group (OR 1.96; 95% CI, 1.26-3.07; I²=0%). For prophylaxis, the discontinuation rate was not significantly different in the 2 groups (isavuconazole vs control, 9.4% vs 17.9%; OR, 2.01; 95% CI, 0.60-6.78).

A pooled analysis of 3 studies that evaluated the incidence of hepatic function abnormalities in treatment showed a significantly increased incidence in the control group vs the isavuconazole group (8.0% vs 16.3%; OR, 2.31; 95% CI, 1.41-3.78).

Among several limitations, most patients had a variety of comorbidities, were treated at different drug dosages, and underwent different durations of therapy. Also, randomized control trials and high-quality observational studies were lacking for various IFI subtypes.

“Our findings suggest that ISAV is a useful first-line antifungal agent for the treatment and prophylaxis of IFIs,” the authors concluded.

This article originally appeared on Dermatology Advisor