Chan Sophea, Stoudenmire Laura Leigh, Chen Xianyan, Zhan Duna, Henao-Martínez Andrés F, Chastain Daniel B
Department of Pharmacy, The Medical Center, Navicent Health, 777 Hemlock Street, Macon, GA 31201, USA.
Research was completed during post graduate training at Phoebe Putney Memorial Hospital and the University of Georgia College of Pharmacy in Albany, GA 31701, USA.
Ther Adv Infect Dis. 2025 Jun 27;12:20499361251347778. doi: 10.1177/20499361251347778. eCollection 2025 Jan-Dec.
While isavuconazole (ISA) has demonstrated non-inferiority to voriconazole (VCZ) for invasive aspergillosis (IA) in clinical trials, real-world comparisons are limited.
To compare treatment completion, adverse events, hospitalizations, and healthcare costs in patients treated with VCZ versus ISA for IA.
Retrospective cohort study using Merative MarketScan claims data (2017-2020).
Adults (⩾18 years) diagnosed with IA (International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes) who received VCZ or ISA monotherapy were included. Treatment completion was defined as ⩾42 days of therapy. Descriptive statistics and logistic regression were used to assess outcomes and predictors of antifungal selection, adverse events, hospitalizations, and treatment completion.
Among 335 patients, 84% ( = 282) received VCZ and 16% ( = 53) received ISA. Baseline characteristics were comparable, although the VCZ group had higher Medicaid enrollment, and the ISA group had more patients with malignancy. Treatment completion rates were comparable (92% each, = 1), as were median treatment durations (VCZ: 120 days, ISA: 112 days, = 0.95). Adverse event rates were not significantly different (VCZ: 49%, ISA: 60%, = 0.18), but CNS-related events occurred more frequently with ISA (16% vs 9%, = 0.32). VCZ was associated with lower outpatient pharmacy costs (median $1,596.68 vs $11,000.66, < 0.001) and total hospitalization costs (median $40,681.89 vs $121,545.89, = 0.01). Malignancy was associated with lower odds of receiving VCZ (OR 0.30, = 0.001), and younger age predicted higher odds of treatment incompletion (OR 0.97, = 0.035). Female sex was associated with increased adverse event risk. Notably, VCZ use was not associated with increased adverse events or treatment incompletion.
VCZ was prescribed five times more frequently than ISA for IA, despite similar treatment durations and completion rates. VCZ was associated with lower costs and did not increase the risk of adverse events or treatment discontinuation. These findings suggest that VCZ remains commonly used and potentially more cost-effective treatment option for IA.
虽然在临床试验中，艾沙康唑（ISA）已证明在治疗侵袭性曲霉病（IA）方面不劣于伏立康唑（VCZ），但现实世界中的比较有限。
比较接受VCZ和ISA治疗IA的患者的治疗完成情况、不良事件、住院情况及医疗费用。
使用默克多市场扫描索赔数据（2017 - 2020年）进行的回顾性队列研究。
纳入诊断为IA（国际疾病分类第十次修订本临床修订版（ICD - 10 - CM）编码）并接受VCZ或ISA单药治疗的成年人（≥18岁）。治疗完成定义为治疗≥42天。使用描述性统计和逻辑回归来评估抗真菌药物选择、不良事件、住院情况和治疗完成情况的结果及预测因素。
在335例患者中，84%（n = 282）接受VCZ治疗，16%（n = 53）接受ISA治疗。尽管VCZ组医疗补助登记人数较多，而ISA组恶性肿瘤患者较多，但基线特征具有可比性。治疗完成率相当（均为92%，P = 1），中位治疗持续时间也相当（VCZ：120天，ISA：112天，P = 0.95）。不良事件发生率无显著差异（VCZ：49%，ISA：60%，P = 0.18），但ISA治疗时中枢神经系统相关事件更频繁发生（16%对9%，P = 0.32）。VCZ与较低的门诊药房费用（中位数1,596.68美元对11,000.66美元，P < 0.001）和总住院费用（中位数40,681.89美元对121,545.89美元，P = 0.01）相关。恶性肿瘤与接受VCZ治疗的较低可能性相关（比值比0.30，P = 0.001），年龄较小预示治疗未完成的可能性较高（比值比0.97，P = 0.035）。女性与不良事件风险增加相关。值得注意的是，使用VCZ与不良事件增加或治疗未完成无关。
对于IA，尽管治疗持续时间和完成率相似，但VCZ的处方频率是ISA的五倍。VCZ与较低成本相关，且不会增加不良事件或治疗中断的风险。这些发现表明，VCZ仍然是IA常用且可能更具成本效益的治疗选择。
