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Efficacy and safety of isavuconazole for invasive fungal infections: A systematic review and meta-analysis of randomized controlled trials

Summary

Isavuconazole is an antifungal medication used to treat serious fungal infections in people with weakened immune systems. This study reviewed and analyzed three clinical trials to compare how well isavuconazole works compared to other antifungal drugs. The results showed that isavuconazole is just as effective as other antifungals but has fewer side effects, particularly fewer problems with liver health and drug-related adverse events. This makes isavuconazole a good alternative choice for patients who cannot use other antifungal medications or who are at risk of liver damage.

Background

Invasive fungal infections (IFIs) are life-threatening, particularly in immunocompromised patients. Conventional antifungals like voriconazole and liposomal amphotericin B are limited by hepatotoxicity, nephrotoxicity, and drug-drug interactions. Isavuconazole (ISA), a third-generation triazole, offers pharmacological advantages including minimal CYP3A4 interaction and no dose adjustment needed for renal impairment.

Objective

This study aimed to assess the efficacy and safety of isavuconazole compared with other antifungal agents through a systematic review and meta-analysis restricted to randomized controlled trials (RCTs), to provide more reliable estimates of its clinical effects.

Results

Three RCTs met inclusion criteria. No statistically significant differences were observed between ISA and comparator agents in clinical response (53.6% vs 59.1%), mortality (30.6% vs 32.0%), or total adverse events. In the subgroup analysis comparing ISA with voriconazole for filamentous fungal infections, ISA showed significantly lower drug-related adverse events (RR: 0.70) and hepatobiliary disorders (RR: 0.57).

Conclusion

ISA demonstrated efficacy comparable to other antifungal agents with a favorable safety profile in patients with IFIs. In subgroup analysis, ISA showed significant safety advantages over voriconazole in drug-related adverse events and hepatobiliary toxicity. This RCT-based meta-analysis provides high-quality evidence supporting ISA as a viable and potentially safer alternative, particularly in patients at risk of hepatotoxicity.
  • Published in:Medical Mycology (Med Mycol),
  • Study Type:Meta-analysis,
  • Source: PMID: 41014230, DOI: 10.1093/mmy/myaf089
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