Isavuconazole Treatment of Cryptococcosis and Dimorphic Mycoses.
George R Thompson, Adrian Rendon, Rodrigo Ribeiro Dos Santos, Flavio Queiroz-Telles, Luis Ostrosky-Zeichner, Nkechi Azie, Rochelle Maher, Misun Lee, Laura Kovanda, Marc Engelhardt, Jose A Vazquez, Oliver A Cornely, John R Perfect
Author Information
George R Thompson: Department of Medicine/Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento.
Adrian Rendon: CIPTIR, Universidad Autónoma de Nuevo León, Monterrey, México.
Rodrigo Ribeiro Dos Santos: Universidade Federal de Minas Gerais, Santa Casa de Belo Horizonte.
Flavio Queiroz-Telles: Department of Public Health Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.
Luis Ostrosky-Zeichner: University of Texas Medical School at Houston and Memorial Hermann-Texas Medical Center.
Nkechi Azie: Astellas Pharma Global Development, Inc, Northbrook, Illinois.
Rochelle Maher: Astellas Pharma Global Development, Inc, Northbrook, Illinois.
Misun Lee: Astellas Pharma Global Development, Inc, Northbrook, Illinois.
Laura Kovanda: Astellas Pharma Global Development, Inc, Northbrook, Illinois.
Marc Engelhardt: Basilea Pharmaceutica International Ltd, Basel, Switzerland.
Jose A Vazquez: Department of Medicine, Division of Infectious Diseases, Medical College of Georgia/Georgia Regents University, Augusta.
Oliver A Cornely: Department of Internal Medicine, Clinical Trials Centre Cologne, ZKS Köln, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Germany.
John R Perfect: Department of Medicine/Division of Infectious Diseases, Duke University, Durham, North Carolina.
BACKGROUND: Invasive fungal diseases (IFD) caused by Cryptococcus and dimorphic fungi are associated with significant morbidity and mortality. Isavuconazole (ISAV) is a novel, broad-spectrum, triazole antifungal agent (IV and by mouth [PO]) developed for the treatment of IFD. It displays potent activity in vitro against these pathogens and in this report we examine outcomes of patients with cryptococcosis or dimorphic fungal infections treated with ISAV. METHODS: The VITAL study was an open-label nonrandomized phase 3 trial conducted to evaluate the efficacy and safety of ISAV treatment in management of rare IFD. Patients received ISAV 200 mg 3 times daily for 2 days followed by 200 mg once-daily (IV or PO). Proven IFD and overall response at end of treatment (EOT) were determined by an independent, data-review committee. Mortality and safety were also assessed. RESULTS: Thirty-eight patients received ISAV for IFD caused by Cryptococcus spp. (n = 9), Paracoccidioides spp. (n = 10), Coccidioides spp. (n = 9), Histoplasma spp. (n = 7) and Blastomyces spp. (n = 3). The median length of therapy was 180 days (range 2-331 days). At EOT 24/38 (63%) patients exhibited a successful overall response. Furthermore, 8 of 38 (21%) had stable IFD at the end of therapy without progression of disease, and 6 (16%) patients had progressive IFD despite this antifungal therapy. Thirty-three (87%) patients experienced adverse events. CONCLUSIONS: ISAV was well tolerated and demonstrated clinical activity against these endemic fungi with a safety profile similar to that observed in larger studies, validating its broad-spectrum in vitro activity and suggesting it may be a valuable alternative to currently available agents. CLINICAL TRIALS REGISTRATION: NCT00634049.
