Isavuconazole (ISV) is a new triazole approved for treatment of mucormycosis and aspergillosis. Data on its effectiveness outside clinical trials and in patients receiving prior triazole prophylaxis(PPx) are lacking.

We conducted a retrospective cohort study on all patients at our academic center 6/1/2015–1/31/2017 who received ISV to determine 6-week response with varying underlying diseases, and previous triazole PPx or treatment. Descriptive statistics and univariate associations were calculated.

33 patients identified including: SOT(5),HSCT(7) recipients,and acute leukemia (18). 25 had lung involvement while 13 had rhino-orbital-cerebral disease. In 13 cases, a fungal pathogen was identified: Mucorales (7) and Aspergillus (6).15 received triazole PPx prior to initiating ISV. 24 received antifungals immediately prior to switching to ISV: amphotericin B (1), fluconazole (1), voriconazole (16), posaconazole (4), and micafungin (2). Switching was often to broaden empiric coverage (18). 6-week response according to subgroups is presented.

6 patients had therapeutic drug monitoring(TDM).Median level (IQR) was 6.75 (5.6–7.0) mcg/mL.Mortality was 36%;45% had complete or partial response. No ISV related adverse effects reported. Patients given ISV following triazole PPx, those undergoing TDM, and those with an identified fungal pathogen had increased odds of complete or partial response ,but did not reach statistical significance as shown.

This is the first study to assess a real-world setting and a heterogeneous population with previous triazole PPX or treatment. Our 6-week response (45%) compares favorably to published trials (35% Aspergillus; 11% Mucorales). Mortality in our study (36%) is comparable to trial results (19% Aspergillus; 35% Mucorales). No major safety signal was observed. Larger cohorts are needed to describe additional real-world ISV use and determine associations with patient outcomes.

CITATION INFORMATION: Hassouna H., Athans V., Brizendine K. Isavuconazole – The Real-World Use Experience Am J Transplant. 2017;17 (suppl 3).

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