A Comparison of Aspergillus Prophylaxis with Voriconazole versus Isavuconazole in Lung Transplant Recipients

Abstract

Purpose Fungal infections are an important cause of mortality and morbidity in lung transplant recipients, and Aspergillus species are the most common cause of infection. Comprehensive consensus guidelines on antifungal prophylaxis against Aspergillus infection in lung transplant recipients has not been established. There are clinical practice variations in Aspergillus prophylaxis, with regards to duration of treatment, choice of agent, and route of administration. Voriconazole is the agent mostly used as Aspergillus prophylaxis. Isavuconazole is a new extended-spectrum triazole with activity against yeasts, molds, and dimorphic fungi but its use as prophylaxis against aspergillosis has not been well studied. Methods We compared the incidence of invasive aspergillosis in single and double lung transplant recipients who used voriconazole versus isavuconazole as prophylaxis. A comprehensive database maintained by the lung transplant program at Keck Medical Center of USC was used to gather data. We started to use isavuconazole as Aspergillus prophylaxis in place of voriconazole in December 2016. Results Sixteen patients in 2015 and 11 patients in 2016 underwent single or double lung transplantation. Nine patients were newly diagnosed with invasive aspergillosis in 2015. After switching to isavuconazole as Aspergillus prophylaxis in 2016, only 3 patients of the 11 that were transplanted were newly diagnosed with invasive aspergillosis. Conclusion Our pilot study reveals that isavuconazole is an effective Aspergillus prophylaxis agent in lung transplant recipients. Isavuconazole has good bioavailability of the oral formulation, predictable pharmacokinetics in adults, few serious adverse effects, and less drug-drug interactions than those noted with voriconazole. Further investigation on use of isavuconazole as Aspergillus prophylaxis is warranted.