Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA.
Department of Pathology and Laboratory Medicine, Fungus Testing Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Antimicrob Agents Chemother. 2022 Sep 20;66(9):e0017722. doi: 10.1128/aac.00177-22. Epub 2022 Aug 15.
Isavuconazole is the newest of the clinically available advanced generation triazole antifungals and is active against a variety of yeasts, molds, and dimorphic fungi. Its current FDA-approved indications include the management of invasive aspergillosis as well as mucormycosis, though the latter indication is supported by limited clinical data. Isavuconazole did not achieve noninferiority to caspofungin for the treatment of invasive candidiasis and therefore lacks an FDA-approved indication for this invasive disease. Significant advantages of isavuconazole, primarily over voriconazole but in some circumstances posaconazole as well, make it an appealing option for the management of complex patients with invasive fungal infections. These potential advantages include lack of QTc interval prolongation, more predictable pharmacokinetics, a less complicated drug interaction profile, and improved tolerability, particularly when compared to voriconazole. This review discusses these topics in addition to addressing the activity of the compound against a variety of fungi and provides insight into other distinguishing factors among isavuconazole, voriconazole, and posaconazole. The review concludes with an opinion section in which the authors provide the reader with a framework for the current role of isavuconazole in the antifungal armamentarium and where further data are required.
伊曲康唑是目前临床应用的新一代三唑类抗真菌药物，对多种酵母、霉菌和二相真菌均具有活性。其目前获得 FDA 批准的适应证包括侵袭性曲霉病和毛霉病的治疗，尽管后者的适应证仅得到有限的临床数据支持。伊曲康唑在治疗侵袭性念珠菌病方面未达到非劣效于卡泊芬净的效果，因此缺乏针对该侵袭性疾病的 FDA 批准适应证。与伏立康唑（但在某些情况下也包括泊沙康唑）相比，伊曲康唑具有显著优势，这使其成为管理侵袭性真菌感染的复杂患者的一种有吸引力的选择。这些潜在优势包括无 QTc 间期延长、更可预测的药代动力学、更简单的药物相互作用谱以及更好的耐受性，尤其是与伏立康唑相比。除了讨论该化合物对各种真菌的活性外，本综述还介绍了其他一些关于伊曲康唑、伏立康唑和泊沙康唑的区别因素。综述最后一部分为观点部分，作者为读者提供了当前伊曲康唑在抗真菌药物中的作用框架，并指出需要进一步的数据来明确其地位。
