New research from NAC on prescribing posaconazole and isavuconazole

Submitted by BethBradshaw on 13 November 2020

The National Aspergillosis Centre is at the forefront of understanding the best ways to treat chronic forms of aspergillosis. Two papers published this month add to the body of knowledge about how newer azoles (posaconazole and isavuconazole) can be used in this patient group.   

Attainment of therapeutic posaconazole serum levels during coadministration with rifampicin (Power et al, 2020)

  • Treating patients affected by co-infections of Aspergillus and Mycobacterium is notoriously difficult because of drug interactions: rifamycin antibiotics are known to switch on liver enzymes that lower the amount of itraconazole/voriconazole in the blood. Staff at the Infectious Diseases department of Wythenshawe Hospital (part of MFT) have expertise in treating both conditions and recently published 2 cases of patients with both NTM-PD and CPA, who were treated twice daily with 300 mg delayed-release posaconazole. Both patients tolerated and responded well to the treatment.

Isavuconazole TDM during long-term treatment for CPA (Kosmidis et al, 2020)

  • Isavuconazole is the newest azole antifungal and was approved for invasive aspergillosis, but less is known about possible side effects among CPA patients, who tend to be immunocompetent and receive treatment for many months. Usually 200 mg daily is prescribed, but here they found that a lower dose (100 mg) was less likely to give side effects and gave a satisfactory level of the drug in the blood. Another study by Furfaro et al (2019) found that around 1 in 3 patients on 200 mg daily isavuconazole experienced side effects (mainly gastrointestinal).


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