Cresemba (isavuconazonium sulfate) / Astellas, Basilea, Pfizer, Grupo Biotoscana, Hikma, Laboratoire Riva, Asahi Kasei Therapeutics, Knight Therap, MedCap AB - LARVOL DELTA

Case Report: Extremely elevated ascitic fluid amylase as a diagnostic clue for peritoneal mucormycosis caused by Rhizopus microsporus following exertional heatstroke. (PubMed, Front Med (Lausanne)) - "The patient received liposomal amphotericin B (L-AmB) plus isavuconazole; subsequent detection of Candida tropicalis superinfection prompted a switch to caspofungin while continuing L-AmB. Combination antifungal therapy achieved cure despite contraindications to surgery. Heatstroke is an important but under-recognized risk factor for disseminated mucormycosis."

Journal • Hematological Disorders • Infectious Disease • Thrombocytopenia

Clinical characteristics and antifungal susceptibility of uncommon Candida species causing candidemia in Southern Taiwan. (PubMed, J Microbiol Immunol Infect) - "Uncommon Candida species exhibited diverse antifungal susceptibility patterns. Host-related factors were associated with 30-day all-cause mortality, whereas no significant association was observed between early antifungal treatment metrics and mortality in this cohort."

Journal • Infectious Disease

From breath to block: Disseminated invasive aspergillosis presenting with pulmonary, ocular, myocardial and cerebral involvement, and high-grade atrioventricular block during acalabrutinib therapy for chronic lymphocytic leukaemia. (PubMed, IDCases) - "The patient was treated initially with intravenous liposomal amphotericin B, before transition to oral isavuconazole following multidisciplinary specialist review. He was eventually palliated due to poor predicted prognosis, and subsequently died. This case highlights the importance of recognising disseminated invasive aspergillosis in patients receiving BTK inhibitor therapy, appreciating that ocular involvement commonly represents haematogenous dissemination rather than the primary site of infection, and considering early multidisciplinary assessment with prompt antifungal therapy when cardiac or central nervous system involvement is suspected."

Journal • Chronic Lymphocytic Leukemia • Hematological Disorders • Hematological Malignancies • Infectious Disease • Leukemia • Ocular Inflammation • Oncology • Ophthalmology • Pulmonary Disease • Respiratory Diseases • Uveitis

Risk stratification of ibrutinib toxicity co-administered with triazole antifungals: insights from real-world pharmacovigilance and clinical evidence. (PubMed, Front Med (Lausanne)) - "Voriconazole-containing reports showed a signal for cerebral aspergillosis (ROR = 474.61, n = 3), posaconazole-containing reports showed cardiac events including pericardial effusion (ROR = 24.95, n = 4), and isavuconazole-containing reports showed a signal for febrile neutropenia (ROR = 29.7, n = 4). The identified pharmacovigilance signals are clinically interpretable in light of known CYP3A-mediated pharmacokinetic interactions, but they should be considered hypothesis-generating rather than causal. These findings support clinical awareness, individualized medication review, and further validation in studies with defined denominators and appropriate control of confounding."

Adverse events • Journal • Real-world evidence • Cardiovascular • Febrile Neutropenia • Hematological Disorders • Neutropenia • Pulmonary Disease • Respiratory Diseases

When the Barrier Breaks: Fatal Invasive Candida Guilliermondii Colitis in Severe Gastrointestinal GVHD (ACG 2026) - "Case Description/ A 43-year-old patient with relapsed mixed phenotype acute leukemia underwent second allogeneic stem cell transplant with double 4/8 umbilical cord donors after Flu/Mel conditioning and cyclosporine/MMF prophylaxis...Necrosis raised concern for fungal colitis, prompting isavuconazole and ruxolitinib escalation to 10 mg BID...Despite antibiotics, micafungin/isavuconazole, and vedolizumab, she died from recurrent GI bleeding due to Candida superinfection of severe, treatment-refractory GVHD enterocolitis...Figure: Figure 2. Laboratory trends through the course"

Candidiasis • Gastroenterology • Gastrointestinal Disorder • Graft versus Host Disease • Hematological Malignancies • Immunology • Infectious Disease • Leukemia

A Pilot Study Evaluating Acalabrutinib for the Treatment of Relapsed/Refractory Primary and Secondary Central Nervous System Lymphomas (ASH 2022) - P2 | "Prophylactic administration of the antifungal agent isavuconazole will be mandatory while subjects receive acalabrutinib. This decision is based on cases of invasive aspergillosis in studies evaluating ibrutinib...Key exclusion criteria include: previous BTKi exposure; anticoagulation with warfarin; strong CYP3A4 inhibitor that cannot be stopped; severe hepatic insufficiency; inability to take oral medication...Additionally, the utility of 82Rubidium as a positron emission tomography-radiotracer will be evaluated (at screening and prior to cycle 3 and cycle 7) in the first five subjects at the University of North Carolina who consent to this scan. Mental status and cognitive function will be evaluated with the mini-mental status examination (MMSE) at screening then every 6 months."

Clinical • Atrial Fibrillation • Cardiovascular • CNS Lymphoma • Gastrointestinal Disorder • Hematological Disorders • Hematological Malignancies • Hepatitis C • Liver Failure • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • Pulmonary Disease • Respiratory Diseases • CXCR4 • MYD88

19-C-0103: Temozolomide, Etoposide, Doxil, Dexamethasone, Ibrutinib, and Rituximab (TEDDI-R) in Aggressive B-cell Lymphomas With Secondary Involvement of the Central Nervous System (CNS) (clinicaltrials.gov) - P2 | N=48 | Active, not recruiting | Sponsor: National Cancer Institute (NCI) | Trial completion date: Jul 2028 ➔ Dec 2029 | Trial primary completion date: Jul 2027 ➔ Dec 2028

Trial completion date • Trial primary completion date • B Cell Lymphoma • Chronic Lymphocytic Leukemia • CNS Lymphoma • Follicular Lymphoma • Hematological Malignancies • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • Secondary Central Nervous System Lymphoma

Phase 1 Study of Escalating Doses of Ibrutinib in Teddi-R with Isavuconazole for Relapsed and Refractory Primary DLBCL of the CNS (ASH 2024) - P1 | "We have previously shown that ibrutinib with temozolomide, etoposide, liposomal doxorubicin, dexamethasone, and rituximab (TEDDI-R) induces durable remissions in relapsed/refractory PCNSL without the need for consolidation, but risks Aspergillus (Lionakis et al...Pts received up to 6 cycles of TEDDI-R with intra-Ommaya cytarabine and no planned maintenance or consolidation...TEDDI-R induces a high rate of complete response in patients with relapsed/refractory PCNSL including those refractory to HD-MTX. Remissions can be durable without consolidation."

P1 data • Atrial Fibrillation • Cardiovascular • CNS Lymphoma • Dermatology • Diffuse Large B Cell Lymphoma • Febrile Neutropenia • Hepatitis B • Hepatology • Human Immunodeficiency Virus • Hypertension • Infectious Disease • Mucositis • Neutropenia • Primary Central Nervous System Lymphoma • Thrombocytopenia • Venous Thromboembolism • Ventricular Tachycardia

Phase 2 Response-Adapted Study of Ibrutinib with Temozolomide, Etoposide, Liposomal Doxorubicin, Dexamethasone, and Rituximab (TEDDI-R) for Secondary CNS Lymphoma (ASH 2023) - P2 | "Pts receive isavuconazole as fungal prophylaxis throughout therapy... Pts with ibrutinib-responsive SCNSL achieve a high rate of CR to TEDDI-R, and preliminary data suggest these remissions are durable. Most ibrutinib-responsive tumors are CD10-negative and enriched for MCD and BN2. TEDDI-R can be delivered as an outpatient to pts of all ages."

P2 data • Anemia • Anorexia • Atrial Fibrillation • B Cell Lymphoma • Cardiovascular • CNS Lymphoma • CNS Tumor • Dermatology • Diffuse Large B Cell Lymphoma • Endocrine Disorders • Fatigue • Febrile Neutropenia • Hematological Malignancies • Human Immunodeficiency Virus • Hypotension • Infectious Disease • Lymphoma • Nephrology • Neutropenia • Non-Hodgkin’s Lymphoma • Pneumonia • Primary Central Nervous System Lymphoma • Renal Disease • Respiratory Diseases • Secondary Central Nervous System Lymphoma • Septic Shock • Thrombocytopenia • BCL2 • BCL6 • MME • MYC

A Practical Alternative to Refine the Estimate of fmCYP3A4 and Evaluate Drug-Drug Interaction Potential for Ziftomenib Using PBPK Modeling to Inform Labeling. (PubMed, CPT Pharmacometrics Syst Pharmacol) - "Moderate or weak interaction (2.6-fold and 1.4-fold increase in AUC) was predicted with itraconazole and isavuconazole, respectively. Approximately 80% reduction in ziftomenib AUC was predicted with rifampicin. Ziftomenib was predicted to be a weak CYP3A4 inhibitor, causing a 1.9-fold increase in midazolam exposure. In the absence of data from dedicated DDI clinical trials, these results were used to support regulatory interactions with the US FDA regarding concomitant administration of ziftomenib with other medications such as CYP3A4 modulators. These modeling results ultimately supported a range of DDI language in ziftomenib label."

Journal • Acute Myelogenous Leukemia • Infectious Disease

High frequency of isavuconazole use over voriconazole for chronic pulmonary aspergillosis: a retrospective observational study on tolerability and therapeutic drug monitoring. (PubMed, Antimicrob Agents Chemother) - "Isavuconazole demonstrated a favorable tolerability profile with no treatment discontinuations due to adverse events. Proactive TDM proved clinically valuable in guiding dose optimization and reducing drug costs, supporting isavuconazole as a viable alternative for long-term CPA management."

Journal • Observational data • Retrospective data • Infectious Disease • Pulmonary Disease • Respiratory Diseases

Hepatotoxicity Signals Across Azole Antifungals: Is Isavuconazole Safer? A Pharmacovigilance Analysis of the FDA Adverse Event Reporting System (FAERS) (IDWeek 2026) - No abstract available

Adverse events • Infectious Disease

Adoption of Isavuconazole in Pediatrics: A Multi-Center Survey (IDWeek 2026) - No abstract available

Clinical • Infectious Disease

Effectiveness and Safety of Isavuconazole Compared with Posaconazole as Primary Antifungal Prophylaxis in High-risk Neutropenic Patients with Hematologic Malignancies and Allogeneic Hematopoietic Cell Transplantation (IDWeek 2026) - No abstract available

Clinical • Infectious Disease

Nationwide Retrospective Analysis of Isavuconazole Treatment for Histoplasmosis (IDWeek 2026) - No abstract available

Retrospective data • Infectious Disease

Isavuconazole versus Alternative Azoles for Invasive Aspergillus in Solid Organ Transplant Recipients (IDWeek 2026) - No abstract available

Clinical • Infectious Disease

Evaluation of Inpatient Isavuconazole Prescribing Practices at a Community‑Based Cancer Center (IDWeek 2026) - No abstract available

Clinical • Infectious Disease

Isavuconazole versus Alternative Azoles for Invasive Aspergillus in Solid Organ Transplant Recipients (IDWeek 2026) - No abstract available

Clinical • Infectious Disease

The Heavy Hitters of Transplant ID (IDWeek 2026) - "Learning Objectives: At the conclusion of this session, participants will be able to:Analyze the epidemiologic exposure risks, timeline after transplantation (early, intermediate, late), and distinct clinical manifestations of major opportunistic pathogens in solid organ (SOT) and hematopoietic stem cell transplant (HSCT) recipients focusing on high-consequence viral (CMV, EBV, BK virus) and invasive fungal pathogens (Aspergillus, Mucorales)Evaluate modern diagnostic modalities for complex transplant-related infections, including quantitative viral PCR monitoring, resistance genotyping (e.g., UL97/UL54 mutations in refactory CMV), and non-invasive fungal biomarkers to guide timely clinical intervention.Develop patient-specific prevention and treatment plans that integrate novel antimicrobial agents (e.g., maribavir, letermovir, isavuconazole), adjust underlying immunosuppressive therapy to balance rejection risk against infection control, and apply preemptive management..."

Infectious Disease

In vitro activity profiles and temporal trends in reduced susceptibility to azoles in Coccidioides in the United States. (PubMed, Antimicrob Agents Chemother) - "Isavuconazole MIC parameters were available during the second period and similar to those of voriconazole. Fluctuations in GM MICs and the percentage of isolates with elevated MICs were observed with fluconazole, itraconazole, and posaconazole, with elevated values observed between 2011 and 2019. Continued surveillance is needed, and outcome data are required to determine if the consistently reduced susceptibility observed with fluconazole or in those infected with strains that have higher MICs results in poorer outcomes in patients with coccidioidomycosis."

Journal • Preclinical • Dermatology • Respiratory Diseases

Clinical characteristics, susceptibility profiles, and outcomes of infection with Alternaria species: a 14-year retrospective study. (PubMed, Med Mycol) - "Posaconazole and itraconazole demonstrated low MICs (MIC₅₀/MIC₉₀: 0.06/0.5 and 0.25/0.5 µg/mL, respectively). Voriconazole and isavuconazole showed higher MIC₅₀/MIC₉₀ (1/2 and 2/4 µg/mL)...Interpretive criteria for Alternaria spp. are needed to guide empiric and definitive therapy."

Journal • Retrospective data • Hematological Disorders • Hematological Malignancies • Immunology • Infectious Disease • Oncology • Solid Organ Transplantation • Transplantation

Clinical pharmacology and therapeutic considerations of isavuconazole in special populations: a narrative review. (PubMed, Int J Antimicrob Agents) - "Potential advantages include fewer neurovisual adverse effects than voriconazole, intravenous use without cyclodextrin-associated renal concerns, and a favorable cardiac profile in patients at risk of QT prolongation. Routine TDM is not supported by a validated universal exposure target; however, selective TDM can be clinically useful when pharmacokinetics are likely to be altered or when toxicity, treatment failure, nonstandard administration, extracorporeal support, or major drug-drug interactions are concerns. This review emphasizes individualized, evidence-informed use and identifies priorities for population specific research."

Journal • Review • Geriatric Disorders • Hematological Disorders • Hematological Malignancies • Hepatology • Human Immunodeficiency Virus • Infectious Disease • Oncology • Pediatrics • Solid Organ Transplantation • Transplantation

Breakthrough rhino-orbito-cerebral mucormycosis caused by Rhizopus arrhizus during posaconazole prophylaxis after allogeneic hematopoietic stem cell transplantation: a case report and focused literature review. (PubMed, Front Med (Lausanne)) - "Additional research-based antifungal susceptibility testing performed during hospitalization using a broth microdilution method in accordance with CLSI M38-Ed3 yielded MICs of 0.25 mg/L for amphotericin B, 0.5 mg/L for posaconazole, and 1 mg/L for isavuconazole. Liposomal amphotericin B and endoscopic surgical debridement were instituted; however, the course was complicated by diagnostic uncertainty, multiple antifungal regimen modifications, persistent hypokalemia during treatment, and eventual discontinuation of active systemic antifungal therapy because of financial constraints. The infection progressed to bilateral visual loss, partial meningeal enhancement with intracranial extension, neurological deterioration, and death 50 days after admission. This case highlights the multifactorial nature of ROCM occurring during mold-active prophylaxis and emphasizes that prophylaxis and negative serum fungal biomarkers should not lower clinical suspicion in high-risk patients."

Journal • Review • Bone Marrow Transplantation • Hematological Malignancies • Infectious Disease • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • Ophthalmology • T Cell Non-Hodgkin Lymphoma • Transplantation

Case Report: Dual toxicity of voriconazole in a CYP2C19 poor metabolizer: a case analysis of life-threatening neutropenia and hepatocellular injury. (PubMed, Front Pharmacol) - "Following discontinuation of voriconazole, antifungal therapy was sequentially changed to isavuconazonium sulfate, nebulized amphotericin B liposome, and intravenous amphotericin B cholesteryl sulfate complex, together with granulocyte colony-stimulating factor and hepatoprotective therapy. This case illustrates a clinical scenario in which pre-emptive pharmacogenomic testing, vigilant monitoring of complete blood counts alongside liver function, and integration with therapeutic drug monitoring (TDM) may enhance safety in patients requiring long-term voriconazole therapy. The absence of TDM data precludes definitive confirmation of voriconazole overexposure; nevertheless, the convergence of CYP2C19 PM genotype, temporal relationship, dechallenge, and structured causality assessment renders presumed drug accumulation the most plausible explanation for the observed toxicities while not excluding all competing contributors."

Journal • Hematological Disorders • Hepatology • Liver Failure • Neutropenia • Pulmonary Disease • Respiratory Diseases • CYP2C19

Uncommon Manifestation of Mucormycosis: Hepatic Abscess Induced by Rhizopus Species in an Immunocompetent Adult Patient (ACG 2026) - "He was initially started on amphotericin B but was switched to isavuconazonium sulfate due to poor tolerance of amphotericin B. Unfortunately, he also did not tolerate isavuconazonium sulfate, and antifungal coverage was changed to posaconazole. Figure: Figure 1. Initial CT abdomen/pelvis, which demonstrates a large, irregularly walled cystic structure in the posterior right hepatic lobe, measuring up to 82.8 mm, concerning for a possible hepatic abscess versus necrotic tumor."

Clinical • Back Pain • Cardiovascular • Diabetes • Dyslipidemia • Gastroenterology • Gastroesophageal Reflux Disease • Heart Failure • Hematological Malignancies • Hepatology • Hypertension • Infectious Disease • Metabolic Disorders • Musculoskeletal Pain • Solid Organ Transplantation