The ‘cephalosporin era’ of triazole therapy: isavuconazole, a welcomed newcomer for the treatment of invasive fungal infections

Abstract

Introduction: Invasive fungal infections remain frequent life-threatening complications in immunocompromised patients. Each of the currently available antifungals has limitations in terms of pharmacokinetic and pharmacodynamic profile, spectrum of efficacy, and tolerability. Isavuconazole (ISA) is a new generation, broad-spectrum triazole that has a favorable spectrum of efficacy and is available in both intravenous and oral forms. Recent Phase III clinical studies showed that ISA had comparable efficacy to voriconazole for the treatment of a variety of mould infections.

Areas covered: This review summarizes the literature on the use of ISA. PubMed was searched for publications in English from 2006 to December 2014 using the terms ‘ISA’, ‘BAL4815’, and ‘BAL 8557’. Relevant publications were reviewed and reference lists were examined for further publications. Conference abstracts from the meeting during 2013 – 2014 were also reviewed.

Expert opinion: ISA is a new broad spectrum triazole antifungal for the treatment of invasive fungal disease available as oral and intravenous formulations, and the ability to be administered as a once-daily regimen. ISA has broad-spectrum in vitro activity, favorable pharmacokinetic profile, and good tolerability. ISA may be considered for primary treatment for a vast variety of invasive fungal infections. Further study of ISA given as prophylaxis, combination, or salvage therapy is warranted.

Keywords:

• Aspergillus
• isavuconazole
• Mucorales
• pharmacodynamics
• pharmacokinetics
• triazole

Declaration of interest

DP Kontoyiannis holds the Frances King Black Endowed Professorship and has received honoraria and research support from Pfizer, Merck, and Astellas. MN Chitasombat has received honoraria from Merck and Astellas. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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