Spotlight on isavuconazole in the treatment of invasive aspergillosis and mucormycosis: design, development, and place in therapy.
Spotlight on isavuconazole in the treatment of invasive aspergillosis and mucormycosis: design, development, and place in therapy.
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DOI：
10.2147/dddt.s145545
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Hoenigl M
中科院分区：
文献类型：
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作者：
Jenks JD;Salzer HJ;Prattes J;Krause R;Buchheidt D;Hoenigl M
近几十年来，侵袭性曲霉病（IA）和毛霉菌病的诊断和治疗取得了重要进展。这些进展之一是艾沙康唑的引入，艾沙康唑是第二代广谱三唑，具有良好的药代动力学和安全性，药物间相互作用很少。在IA和毛霉菌病患者中进行的III期试验表明，艾沙康唑治疗IA的疗效与伏立康唑相似（SECURE试验），治疗毛霉菌病的疗效与脂质体阿替霉素B相似（VITAL试验，随后进行病例对照分析），并且与伏立康唑相比，其安全性良好，眼部、肝胆、皮肤和软组织不良事件显著减少。因此，最近的IA指南推荐艾沙康唑（与伏立康唑一起）作为基础恶性血液病患者IA的金标准治疗。与脂质体毛癣菌素B相比，艾沙康唑可安全地用于肾功能降低的患者，并且常用于治疗肾功能降低患者的毛癣菌病。需要更新毛霉菌病指南，以反映当前的证据，并提供艾沙康唑治疗毛霉菌病的指导。需要进行研究以评估艾沙康唑在以下方面的作用：1）高危患者的抗霉菌预防，2）IA和毛霉病的挽救治疗，3）其他霉菌感染（如尖端赛多孢子菌）的治疗。
In recent decades, important advances have been made in the diagnosis and treatment of invasive aspergillosis (IA) and mucormycosis. One of these advances has been the introduction of isavuconazole, a second-generation broad spectrum triazole with a favorable pharmacokinetic and safety profile and few drug–drug interactions. Phase III trials in patients with IA and mucormycosis demonstrated that isavuconazole has similar efficacy to voriconazole for the treatment of IA (SECURE trial) and liposomal amphotericin B for the treatment of mucormycosis (VITAL trial with subsequent case–control analysis) and a favorable safety profile with significantly fewer ocular, hepatobiliary, and skin and soft tissue adverse events compared to voriconazole. As a result, recent IA guidelines recommend isavuconazole (together with voriconazole) as gold standard treatment for IA in patients with underlying hematological malignancies. In contrast to liposomal amphotericin B, isavuconazole can be safely administered in patients with reduced renal function and is frequently used for the treatment of mucormycosis in patients with reduced renal function. Updated guidelines on mucormycosis are needed to reflect the current evidence and give guidance on the use of isavuconazole for mucormycosis. Studies are needed to evaluate the role of isavuconazole for 1) anti-mold prophylaxis in high-risk patients, 2) salvage treatment for IA and mucormycosis, and 3) treatment for other mold infections such as Scedosporium apiospermum.