Isavuconazole in chronic pulmonary aspergillosis: What is the evidence?

IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES
Vitor Falcão de Oliveira , Mariane Taborda , Jéssica Toshie Katayose , Bruno Victor dos Santos Prates , Isadora Cristina de Souza Ritter , Adriana Satie Gonçalves Kono Magri , Edson Abdala , Marcello Mihailenko Chaves Magri
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Abstract

Background

Newer drugs like isavuconazole have been more widely used for invasive aspergillosis, where they are included as first-line treatments in major guidelines, whereas their use in chronic pulmonary aspergillosis (CPA) remains limited. Therefore, the aim of this study is to conduct a systematic review of the literature on the use of isavuconazole in CPA.

Methods

We searched PubMed/MEDLINE and Embase on August 9th, 2024. Our inclusion criteria included patients with CPA who were treated with isavuconazole. We summarized binary variables with counts and percentages, and continuous variables with mean and SD.

Results

We found 15 articles on CPA using isavuconazole. These studies were published after 2017, with a high predominance in high-income countries, especially US (40 %, n = 6) and UK (33.3 %, n = 5). There were 10 case reports, the majority of which used isavuconazole as salvage therapy. Two articles compared isavuconazole with voriconazole. The overall response rates at the end of treatment for CPA patients were similar, and the incidence of adverse drug reactions was numerically lower in the isavuconazole group compared to voriconazole. We found five articles on blood levels of isavuconazole. The mean isavuconazole serum level was >1 mg/L in all studies, even at a 100-mg daily dose. In the retrospective studies, the rate of isavuconazole discontinuation ranged from 17 % to 36 %.

Conclusion

There is limited experience with isavuconazole in treating CPA. This study consolidates existing evidence on its use in CPA, highlighting its potential as a therapeutic option beyond invasive aspergillosis, though further research is needed.
异武唑治疗慢性肺曲霉菌病:证据是什么?
isavuconazole等较新的药物已更广泛地用于侵袭性曲霉病,在主要指南中被列入一线治疗,而它们在慢性肺曲霉病(CPA)中的应用仍然有限。因此,本研究的目的是对isavuconazole在CPA中的应用文献进行系统综述。方法于2024年8月9日检索PubMed/MEDLINE和Embase。我们的纳入标准包括使用异唑康唑治疗的CPA患者。我们用计数和百分比总结二元变量,用均值和SD总结连续变量。结果共发现15篇使用异戊康唑的CPA。这些研究发表于2017年以后,在高收入国家,尤其是美国(40%,n = 6)和英国(33.3%,n = 5)的发生率较高。共有10例报告,其中大部分使用异唑康唑作为补救性治疗。两篇文章比较了异戊康唑和伏立康唑。治疗结束时CPA患者的总有效率相似,与伏立康唑组相比,isavuconazole组的药物不良反应发生率在数值上更低。我们找到了五篇关于异舒康唑血药浓度的文章。在所有研究中,isavuconazole的平均血清水平为1mg /L,即使每日剂量为100mg。在回顾性研究中,异戊康唑的停药率为17% - 36%。结论依舒康唑治疗CPA经验有限。这项研究巩固了其在CPA中使用的现有证据,强调了其作为侵袭性曲霉病之外的治疗选择的潜力,尽管需要进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Infection and Chemotherapy
Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
4.10
自引率
4.50%
发文量
303
审稿时长
47 days
期刊介绍: The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.
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