Isavuconazole: Has It Saved Us? A Pharmacotherapy Review and Update on Clinical Experience

Opinion statement

The new triazole antifungal, isavuconazole, gained approval in 2015 for the treatment of invasive aspergillosis (IA) and mucormycosis in adult patients. Predictable pharmacokinetics, a favorable safety profile, and demonstrated clinical efficacy against a wide spectrum of yeasts and molds result in expansion of the antifungal armamentarium. The place in therapy for this medication has yet to be defined. This review aims to place isavuconazole's role in therapy in perspective. Three studies evaluate isavuconazole activity in the treatment of IA, mucormycosis, and candidiasis. Isavuconazole was non-inferior to voriconazole in the treatment of IA and had similar outcomes to liposomal amphotericin (L-AMB) and posaconazole in the treatment of mucormycosis. Isavuconazole did not meet a priori non-inferiority margins for superior clinical outcome response in the treatment of candidemia. Cost-effectiveness analyses compare isavuconazole to other treatment options with favorable outcomes regarding isavuconazole use. Considering the potential for substantial cost savings, non-inferiority to L-AMB and other triazoles in terms of efficacy, a more favorable safety profile, and an oral formulation, isavuconazole has advantages over current standard of care for the treatment of IA and mucormycosis. For other invasive fungal infections including candidiasis, clinical outcome data and cost-effectiveness analysis are needed. Isavuconazole is a safe, effective, and fiscally responsible treatment option for the treatment of IA and mucormycosis.

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