Isavuconazole: A New Option for the Management of Invasive Fungal Infections.
OBJECTIVE
To review the pharmacology, chemistry, in vitro susceptibility, pharmacokinetics, clinical efficacy, safety, tolerability, dosage, and administration of isavuconazole, a triazole antifungal agent.


METHODS
Studies and reviews were identified through an English language MEDLINE search (1978 to March 2015) and from http://www.clinicaltrials.gov, Food and Drug Administration (FDA) briefing documents, program abstracts from international symposia, and the manufacturer's Web site.


METHODS
All published and unpublished trials, abstracts, in vitro and preclinical studies, and FDA briefing documents were reviewed.


RESULTS
Isavuconazole has activity against a number of clinically important yeasts and molds, including Candida spp, Aspergillus spp, Cryptococcus neoformans, and Trichosporon spp and variable activity against the Mucorales. Isavuconazole, available for both oral and intravenous administration, is characterized by slow elimination allowing once-daily dosing, extensive tissue distribution, and high (>99%) protein binding. The most commonly reported adverse events, which are mild and limited in nature, include nausea, diarrhea, and elevated liver function tests. Its drug interaction potential appears to be similar to other azole antifungals but less than those observed with voriconazole. Comparative trials are under way or have been recently completed for the treatment of candidemia, invasive candidiasis and aspergillosis, and rare mold infections.


CONCLUSIONS
Isavuconazole has a broad spectrum of activity and favorable pharmacokinetic properties, providing an advantage over other currently available broad-spectrum azole antifungals and a clinically useful alternative to voriconazole for the treatment of invasive aspergillosis. It may also prove useful for the treatment of candidemia and invasive mold infections; however, these indications await the results of clinical trials.
University of Chicago Medicine, University of Chicago Medical Center, Chicago, IL, USA.
Natasha N
NN
Pettit
University of Michigan College of Pharmacy, Ann Arbor, MI, USA University of Michigan Health System, Ann Arbor, MI, USA peg@umich.edu.
Peggy L
PL
Carver
D000818:Animals; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy; D058387:Candidemia / Q000188:drug therapy; D002177:Candidiasis / Q000188:drug therapy; D058365:Candidiasis, Invasive / Q000188:drug therapy; D002986:Clinical Trials as Topic; D025141:Drug Resistance, Fungal; D006801:Humans; D009570:Nitriles / Q000494:pharmacology / Q000627:therapeutic use*; D011725:Pyridines / Q000494:pharmacology / Q000627:therapeutic use*; D014230:Triazoles / Q000494:pharmacology / Q000627:therapeutic use*; D065819:Voriconazole / Q000627:therapeutic use
D000935:Antifungal Agents; D009570:Nitriles; D011725:Pyridines; D014230:Triazoles; C508735:isavuconazole; D065819:Voriconazole
Mucor; antifungal agents; aspergillosis; candidiasis; invasive fungal infections; isavuconazole; mold infections; pharmacokinetics; triazole