Clinical experience with isavuconazole in healthy volunteers and patients with invasive aspergillosis in China, and the results from an exposure-response analysis

Mycoses. 2021 Apr;64(4):445-456. doi: 10.1111/myc.13233. Epub 2021 Jan 31.

Abstract

Background: Isavuconazole is a broad-spectrum triazole for the treatment of invasive fungal disease (IFD).

Objective: To investigate the clinical experience with isavuconazole in Chinese individuals.

Patients/methods: Participants were Chinese healthy volunteers from a Phase I pharmacokinetics (PK) and safety study of single/multiple doses of isavuconazole (n = 36) and Chinese patients from the global Phase III SECURE study that assessed safety and efficacy of isavuconazole vs voriconazole for IFD treatment (n = 26).

Results: No clinically relevant differences in PK were found between Chinese and Western participants, although exposure was increased in Chinese volunteers. Treatment-emergent adverse events (TEAEs) were reported in 75.0% of healthy volunteers, many of which were infusion-related. No serious AEs were reported. In SECURE, findings in Chinese patients (n = 26) were similar to the global population. For patients who received ≥1 dose of study drug, allcause mortality from first dose to Day 42 was 10.0% (1/10) with isavuconazole and 25.0% (4/16) with voriconazole (treatment difference [95% confidence interval, CI]: -15.0% [-43.2%, 13.2%]). Overall response at the end of treatment for patients with proven/probable IFD was 25.0% and 16.7% with isavuconazole and voriconazole, respectively (treatment difference [95% CI] -8.3% [-60.2%, 43.5%]). Isavuconazole was associated with lower incidence of hepatobiliary, eye, skin, subcutaneous tissue and psychiatric disorders compared with voriconazole and lower incidence of treatment-related TEAEs, serious TEAES or death overall.

Conclusions: Although further research is required, this study demonstrated a favourable risk-benefit profile of isavuconazole in Chinese patients.

Keywords: antifungal activity; antifungal agents; aspergillosis.

Publication types

  • Clinical Trial, Phase I
  • Randomized Controlled Trial

MeSH terms

  • Administration, Intravenous
  • Administration, Oral
  • Antifungal Agents / pharmacokinetics*
  • Antifungal Agents / therapeutic use*
  • Asian People
  • Aspergillosis / drug therapy*
  • China
  • Healthy Volunteers / statistics & numerical data*
  • Human Experimentation
  • Humans
  • Invasive Fungal Infections / ethnology
  • Nitriles / adverse effects
  • Nitriles / pharmacokinetics*
  • Nitriles / therapeutic use*
  • Pyridines / adverse effects
  • Pyridines / pharmacokinetics*
  • Pyridines / therapeutic use*
  • Treatment Outcome
  • Triazoles / adverse effects
  • Triazoles / pharmacokinetics*
  • Triazoles / therapeutic use*

Substances

  • Antifungal Agents
  • Nitriles
  • Pyridines
  • Triazoles
  • isavuconazole