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Prophylaxis and Treatment of Invasive Aspergillosis: Who and How of Prophylaxis, Treatment, and New Therapies

  • Fungal Infections (O De la Cruz and F Silveira, Section Editors)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose of review

To discuss the approach to antifungal prophylaxis and treatment for invasive aspergillosis in immunocompromised patients with hematologic malignancies, hematopoietic stem cell transplant, and solid organ transplant recipients.

Recent findings

Primary prophylaxis against Aspergillus is recommended for patients with acute myelogenous leukemia receiving remission-induction chemotherapy. Posaconazole or voriconazole are appropriate antifungal agents. A new formulation of itraconazole (SUBA-itraconazole) is an alternative option. Breakthrough infections on isavuconazole prophylaxis have been recently reported. For liver transplant recipients, targeted prophylaxis is recommended in the presence of certain risk factors.

Voriconazole and isavuconazole are the preferred agents for the treatment of invasive aspergillosis. Isavuconazole, a novel extended-spectrum triazole with activity against Aspergillus and Mucorales, was found to be non-inferior compared to voriconazole. Combination of voriconazole with an echinocandin is generally not recommended. Reduction in immunosuppression is recommended as part of the management of invasive aspergillosis. The adjunctive use of interferon-γ may be considered in patients with severe or refractory disease, although a benefit has not been clearly demonstrated.

Summary

The approach to prevention and treatment of invasive aspergillosis has evolved along with changes in immunosuppressive treatment and introduction of novel antifungal agents.

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Authors and Affiliations

  1. Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA

    Paschalis Vergidis MD, MSc

  2. Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    David W. Denning MB, BS, FRCPA, FRCPath

  3. National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    David W. Denning MB, BS, FRCPA, FRCPath

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  1. Paschalis Vergidis MD, MSc
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Correspondence to Paschalis Vergidis MD, MSc.

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Conflict of interest

Dr. Vergidis reports that he has received honoraria from Pfizer.

Dr. Denning reports that he and his family hold Founder shares in F2G Ltd., a University of Manchester spin-out antifungal discovery company. He acts or has recently acted as a consultant to Scynexis, Cidara, Pulmatrix, Zambon, iCo Therapeutics, Roivant, and Fujifilm. In the last 3 years, he has been paid for talks on behalf of Dynamiker, Hikma, Gilead, Merck, Mylan, and Pfizer. He is a longstanding member of the Infectious Disease Society of America Aspergillosis Guidelines group, the European Society for Clinical Microbiology and Infectious Diseases Aspergillosis Guidelines group, and the British Society for Medical Mycology Standards of Care committee.

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This article does not contain any studies with animal subjects performed by any of the authors. David Denning has contributed to a clinical trial (ref 48).

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Vergidis, P., Denning, D.W. Prophylaxis and Treatment of Invasive Aspergillosis: Who and How of Prophylaxis, Treatment, and New Therapies. Curr Treat Options Infect Dis 12, 54–70 (2020). https://doi.org/10.1007/s40506-020-00213-w

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