Isavuconazole is a second-generation
triazole with activity against a broad spectrum of clinically important fungi. Its water-soluble
prodrug,
isavuconazonium sulfate (Cresemba®), available in interchangeable intravenous and oral formulations, is approved in the USA and EU for the treatment of adults with invasive
aspergillosis and
mucormycosis. In international phase III clinical trials,
isavuconazole was efficacious and generally well tolerated in the treatment of these life-threatening diseases. In the phase III SECURE trial,
isavuconazole was non-inferior to
voriconazole for the primary treatment of invasive mould disease (primarily
aspergillosis) and was associated with fewer
drug-related treatment-emergent adverse events (TEAEs) than
voriconazole. In addition, the single-arm, phase III VITAL trial and a matched case-control analysis of
isavuconazole- versus amphotericin B-treated patients provided evidence of the efficacy of
isavuconazole in the treatment of
mucormycosis. The most commonly reported TEAEs among
isavuconazole recipients were
gastrointestinal disorders such as
nausea,
vomiting and diarrhoea.
Isavuconazole has several other attributes that make it a useful new treatment option for these invasive mould diseases, including predictable pharmacokinetics, excellent bioavailability, no food effect with the oral formulation, and its potential utility in renally impaired patients given the absence of
cyclodextrin in the intravenous formulation.