Isavuconazole utilization in a Spanish tertiary hospital.

Abstract

Background: Invasive fungal infections pose a clinical challenge due to their high morbidity and mortality. Since its introduction in 2016, isavuconazole has emerged as a new therapeutic option, highlighting the need to evaluate its use in real-world clinical practice.

Aims: The aim of this study was to evaluate the appropriateness of isavuconazole prescription in accordance with its drug label and the pharmacotherapeutic guidelines of Hospital Universitario de La Princesa, as well as to characterize the patient population receiving this treatment.

Methods: This was a retrospective observational study of prescription-indication. All patients who received isavuconazole during hospitalization between January 2019 and June 2023 were included. Data were obtained by reviewing electronic medical records.

Results: A total of 129 patients were assessed, with 63.3% of these patients being male and a median age 63. Seventy seven percent suffered from malignant haematological diseases and 10.9% had been diagnosed with COVID-19 pneumonia with no other risk factor for invasive fungal infection. The percentage of inappropriate prescriptions was 22.5% (95% confidence interval: 15.2-29.8%). The main reasons for inappropriateness were prophylactic use (10.9%) and treatment of a non-indicated pathogen (4.7%). The frequency of prescription followed an upward trend, although goodness-of-fit to a linear regression model was low.

Conclusions: The level of inappropriateness observed (15-30%) is relatively low compared to other studies on antifungal use, and the frequency of prescription does not exhibit a significant increase over the years. Although adherence to local and international prescribing guidelines remains suboptimal, these data demonstrate a relatively effective integration of isavuconazole into the hospital's therapeutic repertoire.