Efficacy and Safety of Isavuconazole in the Treatment of Invasive Fungal Disease in Patients with Hematological Disorders

Objective: Invasive fungal disease (IFD) poses a significant threat to patients suffering from hematological disorders with high morbidity and mortality. isavuconazole has shown promising efficacy and safety in treating IFD caused by various pathogens including but not limited to Aspergillus and Mucor species in the previous studies. Thus, this retrospective single-arm case analysis study was conducted to evaluate the efficacy and safety of isavuconazole in patients with hematological disorders.

Method: This study included 12 patients diagnosed with IFD (including proven/probable/possible IFD) between August 2022 and March 2023 who underwent isavuconazole treatment for a minimum duration of 7 days. Only patients who received itraconazole monotherapy were involved, with 4 of whom taking initial treatment while 8 receiving isavuconazole as salvage therapy.

Results: Among the 12 patients included in this study, 7 were diagnosed with invasive aspergillosis and 5 were diagnosed with invasive mucormycosis. The median duration of isavuconazole treatment was 43.5 (11-86) days. At the conclusion of the treatment, the overall response (OR) rate for all patients was 67% (8/12), with a complete response rate of 42% (5/12) and a partial response rate of 25% (3/12). Among patients receiving initial treatment, 75% (3/4) patients achieved OR, while 62.5% (5/8) patients approached OR among those receiving salvage therapy. Importantly, only 1 patient experienced an increase in transaminases without demand to discontinuing isavuconazole treatment. Besides, no patients withdraw isavuconazole therapy due to other adverse reactions.

Conclusions: The study results demonstrate that isavuconazole exhibits both effect and safety in the treatment of invasive fungal disease in patients with hematological disorders. Furthermore, there are indications that initial antifungal treatment with itraconazole may yield higher response rates.