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

Summary

This study reviewed clinical trials comparing a newer antifungal drug called isavuconazole with other commonly used antifungal medications for treating serious fungal infections, particularly in patients with weakened immune systems. The research found that isavuconazole works just as well as other antifungal drugs but may have fewer side effects, especially liver problems. When compared directly with voriconazole, isavuconazole showed fewer drug-related side effects overall, making it a good alternative option for patients who cannot tolerate other antifungal treatments.

Background

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

Objective

This systematic review and meta-analysis aimed to assess the efficacy and safety of isavuconazole compared with other antifungal agents through an analysis restricted to randomized controlled trials (RCTs), to provide reliable evidence for clinical practice.

Results

Three RCTs were included with no statistically significant differences 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 and voriconazole for filamentous fungal infections, ISA showed significantly lower incidence of drug-related adverse events (RR: 0.70) and hepatobiliary disorders (RR: 0.57).

Conclusion

ISA demonstrates efficacy comparable to other antifungal agents with a favorable safety profile in treating IFIs. Notably, when compared with voriconazole for filamentous fungal infections, ISA offers significant advantages in reducing drug-related adverse events and hepatobiliary toxicity, supporting its use as a viable alternative, particularly in patients at risk of hepatotoxicity.
  • Published in:Medical Mycology,
  • Study Type:Meta-analysis, Systematic Review,
  • Source: PMID: 41014230, DOI: 10.1093/mmy/myaf089
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