Isavuconazole and voriconazole for the treatment of chronic pulmonary aspergillosis: A retrospective comparison of rates of adverse events

Mycoses. 2019 Mar;62(3):217-222. doi: 10.1111/myc.12885. Epub 2019 Jan 15.

Abstract

Background: Long-term oral triazole antifungal therapy is the cornerstone of management for patients with chronic pulmonary aspergillosis (CPA). Itraconazole is the first-line choice of treatment. Voriconazole, posaconazole or isavuconazole can be used as alternative treatments in case of resistance or intolerance. All of these can cause significant adverse drug reactions.

Objectives: To evaluate how CPA patients tolerate voriconazole and isavuconazole after prior triazole therapy.

Methods: We performed a retrospective observational study at the UK National Aspergillosis Centre. Medical records for all consecutive CPA patients started on isavuconazole and voriconazole during an observation period of 12 and 6 months respectively were analysed.

Results: During this study period, 20 patients were started on isavuconazole and 21 patients on voriconazole. Adverse events were seen in 18 of 21 (86%) the patients in the voriconazole group and 12 of 20 (60%) in the isavuconazole group (P = 0.02). For those who developed adverse events to these agents, the rates of discontinuation of therapy were comparable (ie 10/18 [56%], voriconazole vs 8/12 [67%], isavuconazole; P = 0.54). Five (25%) patients in the isavuconazole group who were intolerant to other triazoles tolerated the standard dose of isavuconazole.

Conclusions: Compared with isavuconazole, adverse events were significantly higher in CPA patients commenced on voriconazole. Isavuconazole may be an option for those patients who are intolerant to other triazoles.

Keywords: adverse events; chronic pulmonary aspergillosis; isavuconazole; voriconazole.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / adverse effects*
  • Chronic Disease
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Drug-Related Side Effects and Adverse Reactions / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nitriles / administration & dosage
  • Nitriles / adverse effects*
  • Pulmonary Aspergillosis / drug therapy*
  • Pyridines / administration & dosage
  • Pyridines / adverse effects*
  • Retrospective Studies
  • Triazoles / administration & dosage
  • Triazoles / adverse effects*
  • United Kingdom
  • Voriconazole / administration & dosage
  • Voriconazole / adverse effects*

Substances

  • Antifungal Agents
  • Nitriles
  • Pyridines
  • Triazoles
  • isavuconazole
  • Voriconazole