Isavuconazole for chronic pulmonary aspergillosis: tolerability and TDM-guided dosing

This real-world cohort quantifies how often voriconazole fails in chronic pulmonary aspergillosis and demonstrates that proactive isavuconazole therapeutic drug monitoring identifies frequent overexposure and enables cost-saving dose reduction.

isavuconazolevoriconazoletriazole antifungalschronic pulmonary aspergillosistherapeutic drug monitoringdose optimizationcost analysisretrospective cohortAspergillus fumigatus Pharmacokinetics / TDM

Background Information

Isavuconazole may trump voriconazole for CPA management in real-world settings.

Isavuconazole may offer better tolerability and lower costs for patients with chronic pulmonary aspergillosis (CPA) compared to voriconazole. 53.8% of patients switched from voriconazole to isavuconazole due to inadequate plasma levels or adverse effects. Isavuconazole required dose adjustments in 50% of patients. This study supports isavuconazole as a viable alternative for long-term CPA management, highlighting its favorable safety and cost profile with therapeutic drug monitoring (TDM). Isavuconazole shows promise for CPA when voriconazole is poorly tolerated or ineffective.

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Authors: Fama F, Conflitti C, Civati A, Cattaneo D, Torre A, Cossu MV, Borghetti S, Visigalli D, Vimercati S, Antinori S, Riva A, Gori A, Colaneri M, Schiuma M

Citation: Fama F, Conflitti C, Civati A, et al. High frequency of isavuconazole use over voriconazole for chronic pulmonary aspergillosis: a retrospective observational study on tolerability and therapeutic drug monitoring. Antimicrobial agents and chemotherapy. 2026:e0089226. doi:10.1128/aac.00892-26

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

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Cost & Logistics

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