de Cossio Tejido Santiago, Salavert Lletí Miguel
Infectious Disease Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.
Infectious Disease Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Research Group in Serious Infection, Health Research Institute La Fe (IIS-La Fe), Valencia, Spain.
Rev Iberoam Micol. 2025 Jan-Mar;42(1):15-21. doi: 10.1016/j.riam.2025.02.002. Epub 2025 Mar 22.
Isavuconazole is a new broad-spectrum antifungal triazole with a better safety profile in terms of drug-drug interactions, adverse effects, and tolerance compared to other azoles. Increasing evidence supports the usefulness of isavuconazole in the treatment of invasive fungal diseases. In this review, we aim to analyze the influence of this new evidence on the main clinical guidelines. We reviewed the most recent consensus guidelines issued by the major infectious diseases societies worldwide, focusing on the novelties regarding the recommendations for the use of isavuconazole in different invasive fungal infections and management strategies. Isavuconazole has been included as first-line therapy for invasive aspergillosis, with slight differences in preference for voriconazole or isavuconazole depending on the clinical scenario. In mucormycosis, isavuconazole is considered an alternative first-line therapy to liposomal amphotericin B, especially in those patients with underlying renal impairment. Additionally, the use of isavuconazole is suggested in salvage scenario for both conditions, and the combination with other mold-active drugs is considered. The guidelines report the promising results obtained with the use of this drug for treating mycoses caused by other molds and rare yeasts, as well as endemic mycoses, but since solid evidence is still lacking, the recommendations in this area are generally weak. Isavuconazole is a suitable therapeutic option for invasive fungal infections, offering efficacy against a range of pathogens, including Aspergillus and fungi within the order Mucorales. Its safety profile and its favorable drug interaction profile make it a valuable alternative to traditional agents like voriconazole or liposomal amphotericin B in certain scenarios. However, continued research is essential to better understand its role in combination therapies and to assess its effectiveness against other fungal species.
艾沙康唑是一种新型广谱抗真菌三唑类药物，与其他唑类药物相比，在药物相互作用、不良反应和耐受性方面具有更好的安全性。越来越多的证据支持艾沙康唑在治疗侵袭性真菌病方面的有效性。在本综述中，我们旨在分析这一新证据对主要临床指南的影响。我们回顾了全球主要传染病学会发布的最新共识指南，重点关注艾沙康唑在不同侵袭性真菌感染中的使用建议和管理策略的新内容。艾沙康唑已被列为侵袭性曲霉病的一线治疗药物，根据临床情况，对伏立康唑或艾沙康唑的偏好略有不同。在毛霉病中，艾沙康唑被认为是脂质体两性霉素B的替代一线治疗药物，尤其是在那些有潜在肾功能损害的患者中。此外，在这两种情况下的挽救治疗中都建议使用艾沙康唑，并考虑与其他抗霉菌活性药物联合使用。指南报告了使用该药物治疗由其他霉菌和罕见酵母菌引起的真菌病以及地方性真菌病所取得的有前景的结果，但由于仍然缺乏确凿证据，该领域的建议通常较为薄弱。艾沙康唑是侵袭性真菌感染的合适治疗选择，对包括曲霉和毛霉目真菌在内的一系列病原体具有疗效。其安全性和良好的药物相互作用特性使其在某些情况下成为伏立康唑或脂质体两性霉素B等传统药物的有价值替代品。然而，持续的研究对于更好地了解其在联合治疗中的作用以及评估其对其他真菌种类的有效性至关重要。
