An Italian prospective, multicentre study by Giacobbe et al. showed a crude mortality rate of 44.0% at 30 days and 62.2% at 90 days in patients with proven or probable invasive aspergillosis receiving isavuconazole treatment while under intensive care. This was lower than rates reported in most of the current literature. A study conducted in Argentina by Posse et al reported a mortality rate of 72.7% in patients with COVID-19–associated pulmonary aspergillosis. Carazo and colleagues in a Spanish study reported a mortality rate of 67% in the same population, and Taccone et al in an international, multicenter (N = 30 centers) observational study of intensive care unit patients, documented a mortality rate of 79% in those with proven invasive aspergillosis.
The seemingly favourable outcomes (lower mortality rates) in the index study were despite the significant association observed between sequential organ failure assessment score, septic shock, and concomitant bacterial pneumonia with 30-day mortality. Similarly, prior hospitalization, sequential organ failure assessment score and septic shock were significantly associated with 90-day mortality, which paradoxically did not increase the risk of unfavourable prognosis as documented in previous studies. Authors of this index study speculate that a favourable prognostic impact of isavuconazole may have accounted for this, but cautioned the applicability of this finding given the lack of comparative groups in the study.
Besides its possible role in reducing mortality rates in the face of negative prognostic factors, as seen in the Italian study, studies have shown the advantages of utilizing isavuconazole compared with first-line voriconazole and other antifungals: lack of QTc interval prolongation, more predictable pharmacokinetics thus obviating therapeutic drug monitoring, a less complicated drug interaction profile, and improved tolerability, particularly when compared to voriconazole. In addition, using certain parameters such as treatment duration, duration of hospitalization, incidence of readmission, clinical response, experience of adverse effects and mortality, Azanza et al and Harrington et al concluded that isavuconazole compares favourably with voriconazole for patients with invasive aspergillosis.
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