USE OF ISAVUCONAZOLE IN PATIENTS WITH COVID- 19 IN AN INTENSIVE CARE UNIT

ABSTRACT

Background and importance Isavuconazole is a new antifungal triazole authorised for invasive aspergillosis and mucormycosis. It is a therapeutic alternative to voriconazole and liposomal amphotericin B for invasive aspergillosis, and to liposomal amphotericin B in mucormycosis. Aim and objectives To analyse prescription characteristics of isavuconazole in patients with COVID-19 in an intensive care unit (ICU) as well as its effectiveness and safety. Material and methods A cross-sectional, observational study was conducted (June 2020-April 2021). Patients with COVID-19 in an ICU on treatment with isavuconazole were included. Electronic prescription program and clinical history were used to collect the following data sex, age, comorbidities, coinfection with other pathogens in addition to SARS-CoV-2, type of therapy (empirical/targeted), duration and previous azole treatment (yes/no). Effectiveness was evaluated by symptoms resolution, reasons for treatment suspension and status (alive/death) 30 days after completion of treatment. Safety was assessed according to adverse events (AE). Results Thirty-three patients (54.5% men) with mean age of 61 (35-77) years were evaluated. Twenty-nine patients (87.9%) had comorbidities, the most frequent were hypertension (19.1%), dyslipidaemia (12.8%), obesity (11.7%) and diabetes (8.5%). Thirty-two (96.9%) had coinfections, with a mean of 1.8 (SD 1.2) infections/patient. The most implicated pathogens were Acinetobacter baumanii (18.8%), Candida albicans (11.6%) and Aspergillus fumigatus (8.7%). Twentythree patients (69.7%) received isavuconazole as empirical therapy and 10 (30.3%) as targeted. Mean duration of treatment was 12.3 (SD 7.5) days. Twenty-five (75.6%) patients had not previously received azole treatment, 7 (21.3%) had received voriconazole and 1 (3%) fluconazole. Symptoms resolution was observed in 12 (36.4%) cases. Seven patients (21.2%) discontinued treatment due to negative culture, 12 (36.4%) due to symptoms resolution and 14 (42.4%) due to death. At 30 days completion of treatment, 15 patients (45.5%) remained alive and 18 (54.5%) had died. AE were recorded in 6 cases (18.2%) liver disorders (n=4) and electrolytic alterations (n=2). Conclusion and relevance Most patients presented comorbidities and coinfections in addition to COVID-19. Effectiveness of isavuconazol was adequate in approximately one-third of patients, despite the high severity and clinical complexity. Approximately half the patients remained alive at 30 days following completion of treatment. Isavuconazol was well tolerated in most cases.