Skip to main content

Advertisement

Log in

Isavuconazole: A Comprehensive Review of Spectrum of Activity of a New Triazole

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

Isavuconazole is a new triazole currently undergoing phase III clinical trials. This compound has shown in vitro activity against a large number of clinically important yeasts and moulds including Aspergillus spp., Fusarium spp., Scedosporium spp., Candida spp., the Zygomycetes and Cryptococcus spp. Similar to voriconazole, reduced in vitro activity is seen against Histoplasma capsulatum. In vivo efficacy has been demonstrated in murine models of invasive aspergillosis and candidiasis. Additionally, there are several potential pharmacokinetic and drug–drug interaction advantages of this compound over existing antifungal agents. This review summarizes existing data that has been either published or presented at international symposia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Guinea J, Pelaez T, Recio S, Torres-Narbona M, Bouza E. In vitro antifungal activities of isavuconazole (BAL4815), voriconazole, and fluconazole against 1, 007 isolates of zygomycete, candida, aspergillus, fusarium, and scedosporium species. Antimicrob Agents Chemother. 2008;52:1396–400.

    Article  CAS  PubMed  Google Scholar 

  2. Illnait-Zaragozi MT, Martinez GF, Curfs-Breuker I, Fernandez CM, Boekhout T, Meis JF. In vitro activity of the new azole isavuconazole (BAL4815) compared with six other antifungal agents against 162 Cryptococcus neoformans isolates from Cuba. Antimicrob Agents Chemother. 2008;52:1580–2.

    Article  CAS  PubMed  Google Scholar 

  3. Warn PA, Sharp A, Denning DW. In vitro activity of a new triazole BAL4815, the active component of BAL8557 (the water-soluble prodrug), against Aspergillus spp. J Antimicrob Chemother. 2006;57:135–8.

    Article  CAS  PubMed  Google Scholar 

  4. Seifert H, Aurbach U, Stefanik D, Cornely O. In vitro activities of isavuconazole and other antifungal agents against Candida bloodstream isolates. Antimicrob Agents Chemother. 2007;51:1818–21.

    Article  CAS  PubMed  Google Scholar 

  5. Warn PA, Hope W, Sharp A, Drusano G, Walsh T, Denning DW. Dose response curves and dose fractionation studies with BAL8557 in a Murine Model of Disseminated Candidiasis. In: Programs and abstracts of the 45th annual international interscience conference on antimicrobial agents and chemotherapy (ICAAC). Washington, DC 2005. Poster B-47.

  6. Ohwada J, Tsukazaki M, Hayase T, et al. Design, synthesis and antifungal activity of a novel water soluble prodrug of antifungal triazole. Bioorg Med Chem Lett. 2003;13:191–6.

    Article  CAS  PubMed  Google Scholar 

  7. Pasqualotto AC, Denning DW. New and emerging treatments for fungal infections. J Antimicrob Chemother. 2008;61(Suppl 1):i19–30.

    Article  CAS  PubMed  Google Scholar 

  8. Warn PA, Sharp A, Mosquera J, et al. Comparative in vivo activity of BAL4815, the active component of the prodrug BAL8557, in a neutropenic murine model of disseminated Aspergillus flavus. J Antimicrob Chemother. 2006;58:1198–207.

    Article  CAS  PubMed  Google Scholar 

  9. Ostrosky-Zeichner L, Inurria N, Rodriguez J, Chen E, Paetznick V. Comparative in vitro activity of isavuconazole (ISA) against medically important yeasts and moulds. In: Programs and abstracts of the 49th annual ICAAC. San Francisco 2009. Poster M-1707.

  10. Curfs-Breuker IM, Mouton J, Debets-Ossenkopp YJ, Endtz HP, Verweij PE, Meis JF. In vitro activity of isavuconazole (BAL4815) compared with seven other antifungal agents against 309 prospectively collected clinical candida isolates from The Netherlands. In: Programs and abstracts of the 17th European congress of clinical microbiology and infectious diseases (ECCMID). Munich 2007. Poster P1978.

  11. Cuenca-Estrella A, Gomez-Lopez A, Buitrago MJ, Mellado E, Rodriguez-Tudela JL. BAL4815 a new antifungal agent: determination of quality control limits for susceptibility testing by methods of the european committee on antimicrobial susceptibility testing (EUCAST). In: Programs and abstracts of the 46th annual ICAAC annual meeting. San Francisco: 2006. Poster M-1571.

  12. Heep M, Grover P, Brown NP, Pillar CM, Jones ME, Sahm DF. Evaluation of isavuconazole e-test compared to broth microdilution antifungal susceptibility testing against quality control strains and clinical candida isolates. In: Programs and abstracts of the 17th European congress of clinical microbiology and infectious diseases (ECCMID). Munich 2007. Poster P-1676.

  13. Sanglard D, Ischer F, Coste A, Rerrari S. Comparison between isavuconazole (ISA) and other azoles against characterized clinical isolates and yeast model systems. In: Abstracts of the eighteenth annual European congress of clinical microbiology and infectious diseases (ECCMID), Barcelona 2008. Poster P-2176.

  14. Thompson GR III, Wiederhold NP, Fothergill AW, Vallor AC, Wickes BL, Patterson TF. Antifungal susceptibilities among different serotypes of Cryptococcus gattii and Cryptococcus neoformans. Antimicrob Agents Chemother. 2009;53:309–11.

    Article  CAS  PubMed  Google Scholar 

  15. Thompson GR III, Fothergill AW, Wiederhold NP, Vallor AC, Wickes BL, Patterson TF. Evaluation of E-test method for determining isavuconazole MICs against Cryptococcus gattii and Cryptococcus neoformans. Antimicrob Agents Chemother. 2008;52:2959–61.

    Article  CAS  PubMed  Google Scholar 

  16. Guinea J, Pelaez T, Tahoune H, Recio S, Torres-Narbona M, Hagen F, Boikhout T, Bouza E. Antifungal activity of old and new antifungal agents against 94 clinical isolates of Cryptococcus neoformans var. grubii and var. neoformans: are there differences between the varieties? In: Programs and Abstracts of the 48th Annual ICAAC Annual Meeting. Washington 2008.

  17. Curfs-Breuker IM, Mouton J, Janssen BGJ, Illnait-Zaragozi, Hagen F. Spanjaard L, Boekhout T, Meis JF. In vitro activity of isavuconazole (BAL4815) Compared with six other antifungal agents against 180 cryptococcus neoformans meningitis isolates from The Netherlands. In: Programs and abstracts of the 17th European congress of clinical microbiology and infectious diseases (ECCMID). Munich 2007. Poster P-1977.

  18. Thompson GR III, Wiederhold NP, Sutton DA, Fothergill A, Patterson TF. In vitro activity of isavuconazole against Trichosporon, Rhodotorula, Geotrichum, Saccharomyces and Pichia species. J Antimicrob Chemother. 2009;64:79–83.

    Article  CAS  PubMed  Google Scholar 

  19. Perkhofer S, Lechner V, Lass-Florl C. In vitro activity of Isavuconazole against Aspergillus species and zygomycetes according to the methodology of the European Committee on Antimicrobial Susceptibility Testing. Antimicrob Agents Chemother. 2009;53:1645–7.

    Article  CAS  PubMed  Google Scholar 

  20. Hibbett DS, Binder M, Bischoff JF, et al. A higher-level phylogenetic classification of the Fungi. Mycol Res. 2007;111:509–47.

    Article  PubMed  Google Scholar 

  21. van Burik JA, Hare RS, Solomon HF, Corrado ML, Kontoyiannis DP. Posaconazole is effective as salvage therapy in zygomycosis: a retrospective summary of 91 cases. Clin Infect Dis. 2006;42:e61–5.

    Article  PubMed  Google Scholar 

  22. Cuenca-Estrella M, Gomez-Lopez A, Mellado E, Buitrago MJ, Monzon A, Rodriguez-Tudela JL. Head-to-head comparison of the activities of currently available antifungal agents against 3, 378 Spanish clinical isolates of yeasts and filamentous fungi. Antimicrob Agents Chemother. 2006;50:917–21.

    Article  CAS  PubMed  Google Scholar 

  23. Wiederhold NP, Lewis RE. Antifungal activity against Scedosporium species and novel assays to assess antifungal pharmacodynamics against filamentous fungi. Med Mycol. 2009;47:422–32.

    Article  CAS  PubMed  Google Scholar 

  24. Badali H, de Hoog S, Curfs-Breuker I, Andersen B, Meis JF. In vitro activitis of 8 antifungal drugs against 70 clinical and environmental isolates of Alternaria spp. In: Programs and abstracts of the 17th international society for human and animal mycoses. Tokyo 2007. Poster PP-03-24.

  25. Ghannoum M, Isham N. Antifungal activity of BAL4815, a novel azole against dermatophytes and emerging non-dermatophyte fungi including zygomycetes. In: Programs and abstracts of the 45th annual ICAAC annual meeting. New Orleans 2005. Poster M-1623.

  26. Gonzalez GM. In vitro activities of isavuconazole against opportunistic filamentous and dimorphic fungi. Med Mycol. 2009;47:71–6.

    Article  CAS  PubMed  Google Scholar 

  27. Badali H, de Hoog S, Curfs-Breuker I, Heep M, Meis JF. In vitro activities of conventional and new antifungal drugs against Rhinocladiella mackenziei an agent of cerebral phaeohyphomycosis. In: Programs and abstracts of the international society for human and animal mycoses (ISHAM). Tokyo 2009. Poster PP-03-23.

  28. Espinel-Ingroff A, Boyle K, Sheehan DJ. In vitro antifungal activities of voriconazole and reference agents as determined by NCCLS methods: review of the literature. Mycopathologia. 2001;150:101–15.

    Article  CAS  PubMed  Google Scholar 

  29. Warn PA, Sharp A, Parmar A, Majithiya J, Denning DW, Hope WW. Pharmacokinetics and pharmacodynamics of a novel triazole, isavuconazole: mathematical modeling, importance of tissue concentrations, and impact of immune status on antifungal effect. Antimicrob Agents Chemother. 2009;53:3453–61.

    Article  CAS  PubMed  Google Scholar 

  30. Warn PA, Sharp A, Majithiya JB, Parmar A, Denning DW. In vitro post antibiotic effect of isavuconazole, voriconazole, and amphotericin B against a strain of C.albicans with concentration dependent pharmacokinetics in a murine model and susceptibility of strains from mouse kidneys post infection. In: Programs and abstracts of the 18th European congress of clinical microbiology and infectious diseases (ECCMID). Barcelona: 2008. Poster P-2177.

  31. Schmitt-Hoffmann A, Roos B, Heep M, et al. Single-ascending-dose pharmacokinetics and safety of the novel broad-spectrum antifungal triazole BAL4815 after intravenous infusions (50, 100, and 200 milligrams) and oral administrations (100, 200, and 400 milligrams) of its prodrug, BAL8557, in healthy volunteers. Antimicrob Agents Chemother. 2006;50:279–85.

    Article  CAS  PubMed  Google Scholar 

  32. Majithiya J, Sharp A, Parmar A, Denning DW, Warn PA. Efficacy of isavuconazole, voriconazole and fluconazole in temporarily neutropenic murine models of disseminated Candida tropicalis and Candida krusei. J Antimicrob Chemother. 2009;63:161–6.

    Article  CAS  PubMed  Google Scholar 

  33. Warn PA, Sharp A, Denning D. Dose response curves and dose fractionation studies with BAL8557 in a murine model of disseminated aspergillosis. In: Programs and abstracts of the 46th ICAAC meeting. San Francisco 2006. A-1120.

  34. Warn PA, Sharp A, Denning DW. Dose response in neutropenic mice with disseminated infection of multiple strains of Aspergillus fumigatus with widely varying MIC and MFC values treated with isavuconazole. In: Programs and abstracts of the 17th ECCMID meeting. Munich 2008. P-1951.

  35. Majithiya JB, Sharp A, Parmar A, Denning DW, Warn PA. Correlation of in vitro MIC and MFC against isavuconazole, voriconazole, and amphotericin B of Aspergillus with in vivo outcome in mice with disseminated Aspergillosis. In: Programs and abstracts of the 18th ECCMID meeting. Barcelona 2008. P1915.

  36. Schmitt-Hoffman A, Roos B, Roehrle M, Spickermann J, Schoetzau A, Simmen U, Heep M. No relevant food effect in man on isavuconazole oral pharmacokinetics preliminary data. In: Programs and abstracts of the 48th annual international interscience conference on antimicrobial agents and chemotherapy (ICAAC). Washington: Poster A-008.

  37. Cornely OA, Böhme A, Reichert D, Heep M, Roos B, Schmitt-Hoffman A, Ullman AJ. Pharmacokinetics, safety and tolerability results from a dose escalation study of isavuconazole in neutropenic patients. In: Programs and abstracts of the 48th annual international interscience conference on antimicrobial agents and chemotherapy (ICAAC). Washington: Poster M-2137.

  38. Schmitt-Hoffman A, Roos B, Peterfai E, Edwards D, Spickermann J, Heep M. Oral pharmacokinetics of isavuconazole in liver impairment due to cirrhosis. In: Programs and abstracts of the 19th European congress of clinical microbiology and infectious diseases (ECCMID). Helskinki 2009. Poster P-1665.

  39. Schmitt-Hoffman A, Roos B, Peterfai E, Edwards D, Spickermann J, Heep M. Pharmacokinetics of isavuconazole in liver impairment—preliminary data. In: Programs and abstracts of the 49th annual ICAAC annual meeting. San Francisco 2009.

  40. Warn P, Denning D, Heep M, Isham N. Ghannoum M. In vitro Activity of a New triazole BAL4815 against Candida isolates with decreased fluconazole susceptibility. In: Abstracts and proceedings of the 45th interscience conferenc on antimicrobial agents and chemotherapy (ICAAC). Washington 2005. Poster M-1620.

  41. Breuker I, Mouton J, Verweij PE, Mouton JW. In vitro activity of the new azole BAL4815 against clinical candida isolates comprising resistant C. albicans and less susceptible Candida spp. In: Abstracts and proceedings of the 45th interscience conference on antimicrobial agents and chemotherapy (ICAAC). Washington 2005. Poster M-1621.

  42. Heep M, Roos B, Sochor M, Schmitt-Hoffmann A, Van Marle S, Kappe D, Voiriot P. QTc measurements during a placebo- and actively controlled multiple dose study of two different dosing regimen of isavuconazole. In: Abstracts and proceedings of the 17th annual European congress of clinical microbiology and infectious diseases (ECCMID). Munich 2007. Poster P-1675.

  43. Viljoen JJ, Mitha I, Heep M, et al. Efficacy, safety, and tolerability of three different dosing regimens of BAL8557 vs fluconazole in a double-blind randomized, multicenter trial for ther treatment of esophageal candidiasis in immunocompromised adults. In: Abstracts of the forty-fifth interscience conference on antimicrobial agents and chemotherapy. Washington 2005. Abstracct LB2-32. American Society for Microbiology, Washington.

  44. Schmitt-Hoffman A, Roos B, Sauer J, et al. Effect of rifampicin on the pharmacokinetics of BAL4815 at steady state after multiple oral doses of BAL8557 (WSA) and rifampicin. In: Abstracts of the sixteenth congress of the international society for human and animal mycology (ISHAM), Paris 2006, P-0319.

  45. Schmitt-Hoffman A, Roos B, Sauer J, et al. Effect of BAL8557, a water-soluble azole pro-drug (WSA), on the pharmacokinetics of S- and R-warfarin. In: Abstracts of the sixteenth congress of the international society for human and animal mycology (ISHAM), Paris 2006, P-0321.

  46. Schmitt-Hoffman A, Roos B, Sauer J, et al. Effect of BAL8557, a water-soluble azole pro-drug (WSA), on the pharmacokinetics of ciclosporin. In: Abstracts of the sixteenth congress of the international society for human and animal mycology (ISHAM), Paris 2006, P-0136.

  47. Schmitt-Hoffman A, Roos B, Sauer J, Maares J, Brown T, Spickermann J, Roehrle M, Thomann P, Heep M. Effect of BAL8557, a Water-soluble Azole Pro-Drug (WSA) on the pharmacokinetics of Tacrolimus. In: Programs and abstracts of the international society of human and animal mycoses (ISHAM). Paris 2006. Poster P-0320.

  48. Wahyuningsih R, SahBandar IN, Theelen B, et al. Candida nivariensis isolated from an Indonesian human immunodeficiency virus-infected patient suffering from oropharyngeal candidiasis. J Clin Microbiol. 2008;46:388–91.

    Article  CAS  PubMed  Google Scholar 

  49. Taj-Aldeen SJ, Al-Ansari N, El Shafei S, et al. Molecular identification and susceptibility of Trichosporon species isolated from clinical specimens in Qatar: isolation of Trichosporon dohaense Taj-Aldeen, Meis & Boekhout sp. nov. J Clin Microbiol. 2009;47:1791–9.

    Article  CAS  PubMed  Google Scholar 

  50. Curfs-Breuker IM, Debets-Ossenkopp YJ, Endtz HP, Verweij PE, Meis JF. In vitro activity of caspofungin compared with six other antifungal agents against 239 prospectively collected clinical Aspergillus isolates from The Netherlands. In: Programs and abstracts of the 3rd advances against Aspergillosis annual meeting. Miami 2008. Poster 37.

  51. Pelaez T, Guinea J, Gama B, Flores R, Recio S, Torres-Narbona M, Munoz P, Bouza E. Is Aspergillus nidulans susceptible to all antifungal agents? in vitro activity of and updated panel of antifungal agents against 63 clinical isolates. In: Programs and abstracts of the 19th european congress of clinical microbiology and infectious diseases (ECCMID). Helskinki 2009. Oral Presentation.

  52. Pelaez T, Gama B, Guinea J, Sanchez-Cambronero L, Martin-Rabadan P, Flores R, Alcala L, Munoz P, Bouza E. Assessment of the antifungal susceptibility of Aspergillus terreus over an 18-year period in a general hospital. In: Programs and abstracts of the 49th annual ICAAC annual meeting. San Francisco 2009. Poster M1714.

  53. Verweij PE, Gonzalez GM, Wiedrhold NP, et al. In vitro antifungal activity of isavuconazole against 345 mucorales isolates collected at study centers in eight countries. J Chemother. 2009;21:272–81.

    CAS  PubMed  Google Scholar 

  54. Nweze EI, Curfs-Breuker I, Janssen BGJ, DeHoog GS, Meis JF. In vitro activity of posaconzole compared with seven antifungal agents against 80 clinical and 15 environmental isolates of Exophiala dermatitidis. In: Programs and abstracts of the 46th annual ICAAC annual meeting. San Francisco 2006. M-1588. P.

  55. Ghannoum M, Isham N. Antifungal activity of BAL4815, a novel azole, against dermatophytes. In: Programs and abstracts of the 2nd annual trends in medical mycology (TIMM). Berlin 2005. Poster P-009.

  56. Breuker I, Mouton J, Verweij PE, Mouton JW. In Vitro activity of the new azole BAL4815 against clinical dermatophyte isolates. In: Programs and abstracts of the 45th annual ICAAC annual meeting. New Orleans 2005. M-1622. P.

  57. Dodds Ashley ES, Lewis R, Lewis JS, Martin C, Andes D. Pharmacology of systemic antifungal agents. Clin Infect Dis. 2006;43:S28–39.

    Article  CAS  Google Scholar 

  58. Schmitt-Hoffmann A, Roos B, Heep M, Brown T. Steady-state bioavailability of oral isavuconazole in healthy volunteers. In: Abstracts and proceedings of the 17th annual European congress of clinical microbiology and infectious diseases (ECCMID). Munich 2007. Poster P-987.

  59. Diflucan [package insert]. New York NR 2004.

  60. Sporanox [package insert]. Titusville NJP 2004.

  61. Posaconazole [package insert]. Kenilworth NSC.

  62. Vfend package insert; Pfizer Inc. NY.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George R. Thompson III.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thompson, G.R., Wiederhold, N.P. Isavuconazole: A Comprehensive Review of Spectrum of Activity of a New Triazole. Mycopathologia 170, 291–313 (2010). https://doi.org/10.1007/s11046-010-9324-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-010-9324-3

Keywords

Navigation