From the Guidelines
Isavuconazole is preferred over voriconazole due to its better safety profile, improved drug interactions, and more convenient dosing regimen, ultimately leading to improved patient outcomes in terms of morbidity, mortality, and quality of life. The advantages of isavuconazole over voriconazole include:
- Better safety profile: Isavuconazole has fewer side effects, particularly less hepatotoxicity and visual disturbances, as noted in the study by 1 and 1.
- Improved drug interactions: Isavuconazole has fewer drug-drug interactions compared to voriconazole, making it easier to use in patients on multiple medications, as mentioned in 1.
- No therapeutic drug monitoring required: Unlike voriconazole, isavuconazole does not require regular blood level monitoring, simplifying patient management.
- Broader spectrum: Isavuconazole is effective against a wider range of fungal pathogens, including some mucormycetes, as discussed in 1.
- More convenient dosing: Isavuconazole has a longer half-life, allowing for once-daily dosing after the initial loading doses, as described in 1.
- No dietary restrictions: Isavuconazole can be taken with or without food, while voriconazole absorption is affected by food intake.
- Better tolerability: Patients generally experience fewer adverse effects with isavuconazole, potentially improving adherence to treatment, as reported in 1 and 1.
For implementation, isavuconazole is typically dosed at 372 mg every 8 hours for 6 doses (48 hours), followed by 372 mg daily, as mentioned in 1. It can be given orally or intravenously. The improved pharmacokinetics and reduced toxicity of isavuconazole are due to its unique chemical structure and metabolism, which result in more predictable drug levels and less accumulation in tissues, as noted in 1. Overall, the use of isavuconazole instead of voriconazole can lead to improved patient outcomes, including reduced morbidity, mortality, and improved quality of life, as supported by the evidence from 1 and 1.
From the Research
Advantages of Isavuconazonium (Isavuconazole) over Voriconazole
- Isavuconazole is non-inferior to voriconazole and is a safe, effective, and better tolerated option for the treatment of invasive aspergillosis 2
- It offers several advantages over other antifungal agents, including having a better adverse event profile with respect to hepatotoxicity, neuro-visual toxicity, QTc prolongation, as well as a stable pharmacokinetic profile obviating the need for therapeutic drug monitoring 2
- Isavuconazole has a lack of QTc interval prolongation, more predictable pharmacokinetics, a less complicated drug interaction profile, and improved tolerability, particularly when compared to voriconazole 3
- The intravenous formulation of isavuconazole does not contain cyclodextrin, which is an advantage over voriconazole, considering the potential for nephrotoxicity of cyclodextrin 4
- Isavuconazole has a favorable safety profile and drug interaction potential in comparison to voriconazole 5
- Isavuconazole is a cost-effective treatment compared to voriconazole for patients with possible invasive aspergillosis, with an incremental cost-effectiveness ratio of 9622.52€ per life year gained and 11,734.79€ per quality-adjusted life year gained 6