atovaquone / Generic mfg. - LARVOL DELTA

Real world treatment outcome with azacytidine (AZA)-tocilizumab (TCZ) for reducing steroid dependence in vexas syndrome with myelodysplastic syndrome (MDS): A single-center, 1.5-year longitudinal observational study (ASH 2025) - "Treatment and outcome: The patient was initiated on high-dose prednisone (PRD) at 40 mg daily and Erythropoiesis-Stimulating Agent, leading to clinical improvement...Acyclovir, atovaquone and voriconazole were used for anti-microbial prophylaxis... As VEXAS syndrome is a novel disease, there is absence of standardized treatment guidelines. This case highlights the promise of AZA-TCZ combination therapy in steroid dependent VEXAS syndrome with MDS. Further investigation into targeted steroid-sparing regimens along with patient specific guidelines is warranted for durable disease control and improved outcomes."

Clinical • HEOR • Observational data • Real-world • Real-world evidence • Eosinophilia • Hematological Disorders • Hematological Malignancies • Inflammation • Leukopenia • Musculoskeletal Diseases • Myelodysplastic Syndrome • Neutropenia • Ocular Inflammation • Ophthalmology • Orthopedics • Renal Disease • Retinal Vein Occlusion • Uveitis

Babesiosis masquerading as ITP in a patient with CLL (ASH 2025) - "Patient's home medications included only ramipril and metoprolol succinate...Patient was started on atovaquone and azithromycin...And patient was diagnosed with Babesiosis. This case highlights how Babesiosis can masquerade as ITP and present as severe thrombocytopenia without any symptoms suggestive of infection."

Clinical • Cardiovascular • Chronic Lymphocytic Leukemia • Coronary Artery Disease • Dyslipidemia • Hematological Disorders • Human Immunodeficiency Virus • Infectious Disease • Metabolic Disorders • Thrombocytopenia • HP

Babesia induced cytokine storm: A rare cause of secondary hemophagocytic lymphohistiocytosis (ASH 2025) - "Initially, this was thought to be a tick-borne illness such as anaplasmosis and doxycycline was empirically started...Treatment with Dexamethasone and Etoposide was initiated per HLH-94 guidelines (Henter et al., 2007)...The tick panel was positive for Babesia, and antibiotics were switched to Azithromycin and Atovaquone...Early identification can prevent further spread including CNS spread and prevent the need for hematopoietic stem cell transplants. Screening tools like HScore distinguish hemophagocytic syndromes such as HLH from sepsis or acute hematologic malignancies, allowing for earlier HLH diagnosis and improved outcomes (Fardet et al., 2014)."

Cytokine storm • Bone Marrow Transplantation • Cardiovascular • Coronary Artery Disease • Hematological Malignancies • Hemophagocytic lymphohistiocytosis • Hepatology • Immunology • Infectious Disease • Rare Diseases • Septic Shock • Thrombocytopenia • IL2 • IL2RA

Pneumocystis jirovecii pneumonia in patients with hematologic malignancy: Risky business, but for whom? (ASH 2025) - "Many of these patients had undergone advanced,immunomodulatory treatments, including 11 (20%) with hematopoietic cell transplantation, 3 (5.5%) withchimeric antigen receptor T-cell therapy, 2 (3.6%) with bispecific T-cell engager therapy, and 16 (29%) withrituximab. Six of the 55 patients (10.9%) were on PJP prophylaxis at the time of infection, including 4(7.3%) on atovaquone and 2 (3.6%) on trimethoprim-sulfamethoxazole... Recent advances in chemo-immunotherapy have drastically altered the treatment landscape for HM,often inducing profound immunosuppression. Our study highlights the importance of optimizing PJPprophylaxis among these patients, particularly those undergoing treatment with novel therapies. Most ofthe patients were not on PJP prophylaxis at the time of diagnosis, underscoring the need to further refinethe institutional guidelines on criteria for prophylaxis."

Clinical • Acute Myelogenous Leukemia • Adult T-Cell Leukemia-Lymphoma • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Hematological Malignancies • Infectious Disease • Leukemia • Lymphoma • Multiple Myeloma • Non-Hodgkin’s Lymphoma • Oncology • Pneumonia • Respiratory Diseases

Survival outcomes in tickborne infection-associated hemophagocytic lymphohistiocytosis treated with antibiotics alone versus antibiotics and HLH-directed therapy: A multicenter real-world study (ASH 2025) - "Patients werestratified into two treatment groups: (1) antimicrobial therapy alone (e.g., doxycycline, atovaquone), and(2) antimicrobial therapy plus HLH-directed therapy (defined as corticosteroids, etoposide, IVIG, oranakinra). In our study, HLH-directed therapy in the context of tickborne infection–associated HLH wasassociated with worse survival compared to antimicrobial therapy alone. The difference in survivalbecame increasingly apparent after 10 days from diagnosis, with persistent separation in time-to-deathanalysis at 14, 30 and 90 days. Higher rates of organ dysfunction in the HLH therapy group may reflectunderlying disease severity, treatment-related toxicity, or inappropriate immunosuppression."

Clinical • Real-world • Real-world evidence • Hemophagocytic lymphohistiocytosis • Immunology • Infectious Disease • Lyme Disease • Rare Diseases

Autoimmune hemolytic anemia: An underrecognized contributor to anemia and hemolysis in babesiosis infection (ASH 2025) - "Most received the standardantibiotic regimen of atovaquone, azithromycin and doxycycline. Data was analyzed for 406 patients. Median age was 73 (range 2 to 103) with a malepredominance (67.5%; 264/406). Asplenia was seen in 10.7% (42/406), and 32.5% (127/406) had Lyme-coinfection."

Anemia • Autoimmune Hemolytic Anemia • Hematological Disorders • Immunology • Infectious Disease

Pyrosequencing analysis of cytochrome b (CYTb) gene mutations in Babesia gibsoni: Correlation with drug resistance and treatment efficacy in South Korea. (PubMed, Vet Parasitol Reg Stud Reports) - "Various treatment regimens were administered based on clinical judgment, including atovaquone-azithromycin (AA), diminazene aceturate, metronidazole-clindamycin-doxycycline (MCD), and doxycycline-enrofloxacin-metronidazole (DEM). Overall, dogs with non-mutated strains tended to respond more favorably to initial treatments, whereas those with mutated strains often required more complex therapeutic approaches. This study supports the value of genetic monitoring in guiding treatment decisions and improving clinical outcomes of canine babesiosis."

Journal • Hematological Disorders • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus

Validation of solvent proteome profiling for antimalarial drug target deconvolution. (PubMed, Int J Parasitol Drugs Drug Resist) - "Here, we successfully generated solvent denaturation curves for the P. falciparum proteome, and demonstrated the utility of SPP with five antimalarial compounds: pyrimethamine, atovaquone, cipargamin, MMV1557817 and OSM-S-106. This alternative method simplifies the experimental workflow and includes positive controls to affirm the performance of the experiment. Overall, this study demonstrates that SPP can be successfully applied in both lysate and live-cell treatment conditions to elucidate drug targets in P. falciparum, as well as providing additional information regarding the mechanisms of drug action, offering insights for the optimisation of existing antimalarials and the development of novel therapies."

Journal • Infectious Disease • Malaria • DHFR • TYMS

Atovaquone-induced oxidative stress activates the pentose phosphate pathway and Immunogenic cell death in ovarian cancer. (PubMed, Sci Rep) - "Moreover, increased expression of ligands for activating receptors of NK cells was observed, and coculture experiments revealed enhanced NK cell activity toward atovaquone-treated cells. These results highlight atovaquone's potential to activate immune responses, offering a new avenue for combination therapies in EOC treatment."

Journal • Epithelial Ovarian Cancer • Gynecologic Cancers • Oncology • Ovarian Cancer • Solid Tumor • CALR • HMGB1 • TFAM

Dual Function of Mitochondrial Complex III in Plasmodium falciparum. (PubMed, bioRxiv) - "MPPα knockdown also resulted in hypersensitivity of the parasites to proguanil, a drug that synergizes with mtETC inhibitors such as atovaquone. Pulldown with MPP α followed by proteomics revealed the association of multiple mitochondrially targeted proteins, in addition to all components of Complex III. These results are consistent with the suggestion that Complex III in P. falciparum serves both mtETC and protein processing functions in mitochondrial physiology."

Journal • Immunology • Infectious Disease • Malaria

Proposal of Chemical Inhibitors That Compete with the Binding of RNA Polymerase II Subunits to Essential GTPases GPN Npa3 and Gpn1. (PubMed, ACS Omega) - "Our analysis identified potential inhibitors, including atovaquone for both Npa3 and Gpn1 (docking scores: -14.4 and -13.5 kcal/mol, respectively) and tibolone for Npa3 (-13.6 kcal/mol), following flexible docking optimization. Additionally, our docking models suggest key residues in Npa3 such as F143 and W179, which may be critical for recognizing RNA polymerase II subunits and drug-like molecules. These findings can be further explored through biochemical and mutagenesis studies to assess their roles in RNA polymerase II recognition."

Journal

A Fatal Case of Hemophagocytic Lymphohistiocytosis Triggered By Babesiosis (ASH 2023) - "Case Presentation: A 77-year-old male with history of deep vein thrombosis (DVT), Parkinson's disease, and lumbar radiculopathy on chronic prednisone, presented for progressive generalized weakness, leg pain, and confusion. HLH should be strongly suspected in patients from endemic regions, especially with additional risk factors such as age, genetics, and immunosuppression. Tools such as the HScore and the HLH-2004 criteria can aid in further patient risk stratification. Urgent treatment with steroids and addressing underlying babesiosis with atovaquone, azithromycin, and potentially red blood cell exchange transfusion, remains crucial for preventing decompensation and improving outcomes."

Clinical • Anemia • Cardiovascular • CNS Disorders • Dyslipidemia • Hematological Disorders • Hemophagocytic lymphohistiocytosis • Hypertriglyceridemia • Immunology • Infectious Disease • Movement Disorders • Musculoskeletal Pain • Pain • Parkinson's Disease • Rare Diseases • Thrombocytopenia • Thrombosis • HP • IL2RA • ISG20

Cumulative Incidence and Characteristics of Infections Requiring Treatment, Delay in Treatment Administration or Hospitalisation in Patients with Relapsed or Refractory Multiple Myeloma Treated with Anti BCMA or Anti GPRC5D Bispecific Antibodies (ASH 2023) - "Among the 229 patients included, 200 (87%) received an anti-BCMA BsAb with teclistamab (n=153, ­67%) or elranatamab (n=47, 20%) and 29 patients (13%) received an anti-GPRC5D BsAb with talquetamab. 40% (n=90) of patients were treated in monotherapy, 42% (n=94) had dexamethasone in addition to the BsAb after step up doses and 18% (n=41) received a combination with an anti CD38, immunomodulatory treatment, proteasome inhibitor or other...Regarding infectious prophylaxis, n=104 (47%) infectious events occurred despite a bacterial prophylaxis (n=104), 91% (n=125) occurred under viral prophylaxis, 73% (n=166) with trimethoprim-sulfamethoxazole or atovaquone and 11% (n=25) with pentamidine use...We describe higher frequency of infections in patients receiving anti-BCMA agents compare to anti-GPRC5D group. Impact on treatment administration is huge and dosing intervals strategy and prophylaxis appear necessary and effective to improve the morbidity and mortality rate of..."

Clinical • CNS Disorders • Hematological Malignancies • Infectious Disease • Multiple Myeloma • Oncology • Rare Diseases • Respiratory Diseases

A review on molecular markers of Plasmodium falciparum. (PubMed, J Parasit Dis) - "Atovaquone resistance can be caused by a variety of mutations in the cytochrome b gene, with the majority of mutations affecting the protein's ubiquinol binding site. Similarly, mutations in the Plasmodium falciparum chloroquine resistance transporter, Plasmodium falciparum multi-drug resistance 1, and an increase in Plasmodium falciparum Plasmepsin II and III copy numbers all lead to 4-aminoquinoline drug resistance...In order to successfully address drug resistance in malaria, it will be essential to strengthen worldwide monitoring systems and promote interdisciplinary collaboration among researchers and healthcare professionals. Furthermore, regular monitoring, identification, and limiting of drug-resistant P. falciparum strains through in vivo efficacy tests, in vitro tests, combination therapy, molecular techniques, and appropriate policies must continue to ensure the effectiveness of malaria treatment."

Biomarker • Journal • Review • Infectious Disease • Malaria • ABCC1 • DHFR

Pneumonia in a Post-Transplant Patient: The Eosinophilic Red Herring (KIDNEY WEEK 2025) - "Case Description A 47-year-old female with kidney failure due to Goodpasture syndrome, status post deceased donor kidney transplant in 2014, maintained on tacrolimus and mycophenolate mofetil (MMF) presented with two weeks of fatigue, shortness of breath, and intermittent fevers...Extensive infectious workup remained unyielding, except for a beta-D-glucan level of >500, following which voriconazole was added...Steroids were started for presumed eosinophilic pneumonia, and trimethoprim-sulfamethoxazole was added simultaneously to cover Pneumocystis Pneumonia (PJP), toxoplasma, and nocardia...She was managed with Atovaquone for 3 weeks...mcfDNA sequencing has improved sensitivity and specificity and favorably impacted the management of PJP Pneumonia. It remains an important differential for eosinophilic pneumonia."

Clinical • Post-transplantation • Acute Kidney Injury • Fatigue • Infectious Disease • Nephrology • Pneumonia • Respiratory Diseases • Transplantation

Entecavir-Associated Fanconi Syndrome in a Liver Transplant Recipient (KIDNEY WEEK 2025) - "While nucleos(t)ide analogs such as adefovir and tenofovir are well-established culprits, especially in HIV or HBV populations, Entecavir is rarely implicated...Case Description A 60-year-old male with HBV-related cirrhosis status-post liver transplantation, chronic antibody-mediated rejection (on Tacrolimus and Prednisone), type 2 diabetes mellitus, and chronic kidney disease (baseline Creatinine (Cr) 1.4–1.6 mg/dL) presented with recurrent falls and altered mental status. Notable medications included Entecavir started 5 years prior , Voriconazole (for phaeohyphomycosis), and Atovaquone/Sulfadiazine (for disseminated toxoplasmosis)...Discussion Occurrence of hallmark features—including phosphaturia, uricosuria, and hyperchloremic metabolic acidosis—suggests a potential class effect of nucleos(t)ide analogs in susceptible individuals. Thus, clinicians should maintain a high index of suspicion for Fanconi syndrome in patients receiving long-term nucleos(t)ide analog..."

Clinical • Antibody-mediated Rejection • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Fibrosis • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Metabolic Disorders • Nephrology • Renal Disease • Transplantation • Type 2 Diabetes Mellitus

Babesia Masquerade: Hemolysis After Kidney Transplant (KIDNEY WEEK 2025) - "Case Description A 32-year-old male from Seattle with ESKD secondary to anti-complement factor H antibody-associated aHUS managed with eculizumab, received a deceased donor kidney transplant in late 2023...Maintenance IS was reduced, and treatment with azithromycin and atovaquone was initiated for six weeks...Although babesiosis is rare in the PNW—with fewer than 1 case per 100,000 population according to CDC data—transfusion-transmitted infection remains a risk when blood is sourced from regions without routine screening. Given national blood redistribution, there is a need to re-evaluate current screening policies—or, at minimum, adopt greater scrutiny when transfusing immunocompromised patients, regardless of regional endemicity"

Anemia • Atypical Hemolytic Uremic Syndrome • Complement-mediated Rare Disorders • Hematological Disorders • Infectious Disease • Musculoskeletal Pain • Nephrology • Transplantation • HP

Severe Babesiosis With Multifactorial Hemolysis and Pulmonary Complications in an Asplenic Patient at a Tertiary Cancer Center. (PubMed, Cureus) - "Initial therapy with clindamycin-atovaquone and partial exchange transfusion was required due to a reported azithromycin allergy; following successful rechallenge, she tolerated guideline-based azithromycin-atovaquone. Third, this case underscores the emerging recognition of complement-mediated autoimmune hemolysis in babesiosis, demonstrated by worsening hemolysis despite parasite clearance and a complement C3-positive, immunoglobulin G (IgG)-negative direct antiglobulin test. Finally, optimal outcomes required a multidisciplinary approach involving infectious disease, hematology, and transfusion medicine specialists, reflecting the complexity of management in severe and atypical babesiosis."

Journal • Allergy • Cytomegalovirus Infection • Dermatology • Epstein-Barr Virus Infections • Fatigue • Hematological Disorders • Hypotension • Immunology • Infectious Disease • Musculoskeletal Pain • Oncology • Pain • Pancreatic Cancer • Respiratory Diseases • Solid Tumor • Thrombocytopenia • Urticaria • HP

Rates of Trimethoprim-Sulfamethoxazole Versus Alternative Pneumocystis Prophylaxis Agents in Patients Undergoing Hematopoietic Stem Cell Transplantation (ASH 2024) - "Atovaquone was the most prescribed alternative agent (n=114; 66%). Use of second- and third-line agents for PJP prophylaxis may provide gaps in antimicrobial coverage. Further data are needed as to whether TMP-SMX may be safely reintroduced in patients who have had the drug discontinued for non-allergy indications, in order to provide optimal PJP prophylaxis for patients who have undergone HSCT."

Clinical • Acute Myelogenous Leukemia • Bone Marrow Transplantation • Cytomegalovirus Infection • Dermatology • Epstein-Barr Virus Infections • Hematological Disorders • Hematological Malignancies • Immunology • Infectious Disease • Leukemia • Lymphoma • Multiple Myeloma • Non-Hodgkin’s Lymphoma • Oncology • Pneumonia • Pruritus • Renal Disease • Respiratory Diseases • Transplantation

Long Term Follow up of a Child with a Rare Hemoglobinopathy: Hemoglobin Little Venice (ASH 2024) - "At 14, she was treated for asymptomatic babesiosis with atovaquone and azithromycin.At present, she continues to require regular transfusions every 4 weeks due to severe hemolytic anemia and has significant thrombocytosis along with leukocytosis and nucleated red blood cells. She has significant transfusion-associated hemosiderosis and receives double chelation with deferasirox and deferiprone with marked history of noncompliance...At present, little is known regarding treatment choices for this rare hemoglobinopathy therefore, we will continue chronic blood transfusions and encourage compliance with iron chelation. A similar variant affecting the same codon, Hb Hammersmith [β42 Phe→Ser, HBB : c.128T>C] has comparatively more data in the literature which may offer some general guidance."

Clinical • Anemia • Gastroenterology • Hematological Disorders • Hepatology • Infectious Disease • Novel Coronavirus Disease • Thrombocytopenia • Thrombocytosis

Atovaquone Dosing for Pneumocystis Jirovecii Pneumonia Prophylaxis in Practice: A Retrospective Review of Dosing Strategies (COSA 2025) - "Conclusion and clinical implications While no PJP infections were observed in the low-dose group, further study with a larger sample and patient risk stratification is required to establish clinical implication. Consideration of low-dose atovaquone in select patients may reduce financial burden and assist patient compliance and tolerability."

Retrospective data • Review • Oncology

A Case of Pneumocystis Pneumonia Caused by Long-Term Low-Dose Steroid Therapy. (PubMed, Cureus) - "We report our experience of managing PCP in an 80-year-old man with a history of rheumatoid arthritis who had been receiving oral prednisolone 4 mg/day for 21 years...These findings led to the suspicion of bacterial pneumonia and initiation of ceftriaxone therapy...On day five, the antibiotic regimen was switched to meropenem, vancomycin, and TMP-SMX...ST and atovaquone were administered for a total of three weeks, resulting in defervescence and significant improvement in oxygenation...Although our patient had been receiving only a low daily dose, the cumulative exposure indicated a high risk for infections such as PCP. In conclusion, our case experience suggests that in patients receiving long-term corticosteroid therapy, PCP and other opportunistic infections must be considered in the differential diagnosis of pneumonia, regardless of the daily corticosteroid dose received."

Journal • Cough • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammatory Arthritis • Pneumonia • Pulmonary Disease • Respiratory Diseases • Rheumatoid Arthritis • Rheumatology • CD4

Atovaquone Attenuates Hypertrophic Cardiomyopathy via MARCH3-Mediated GP130 Degradation (AHA 2025) - "The use of leupeptin, but not MG132, reversed GP130 downregulation, confirming lysosomal pathway specificity.CONCLUSIONThis study identifies Atovaquone as a repurposed, disease-modifying candidate for HCM therapy. By targeting MARCH3 and inducing lysosomal degradation of GP130, it disrupts pathological STAT3 signaling. These findings provide both mechanistic insight and translational potential for a novel therapeutic approach in HCM."

Cardiomyopathy • Cardiovascular • Fibrosis • Hypertrophic Cardiomyopathy • Immunology • Targeted Protein Degradation

Treatment of Dapsone-Induced Methemoglobinemia in a Transplant Recipient With Isosulfan Blue Allergy (ACG 2025) - "1 month post-LT, pneumocystis jirovecii pneumonia (PJP) prophylaxis was switched from sulfamethoxazole/trimethoprim (SMZ/TMP) to dapsone due to renal impairment...Dapsone was switched to atovaquone, which was not tolerated due to nausea; and was restarted 21 days later. Other medications included tacrolimus, cellcept and valcyte...Cimetidine use was weighed with balancing the risks for kidney injury due to acute interstitial nephritis with recent KT with improvement in MethHb.Figure: Figure 1. Methemoglobin Level after Cimetidine Initiation*Day of Cimetidine 400mg TID for 5 days initiation"

Clinical • Allergy • Anemia • Fatigue • Fibrosis • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Leukopenia • Metabolic Dysfunction-Associated Steatohepatitis • Nephrology • Pneumonia • Pulmonary Disease • Renal Disease • Respiratory Diseases • Transplantation • G6PD • HP

A Case of Catastrophic Antiphospholipid Syndrome Manifesting as Abdominal Pain (ACG 2025) - "He was treated with another steroid course, plasmapheresis, and Rituximab, with significant improvement. He was discharged home on prednisone, atovaquone, pantoprazole, warfarin, and vitamin D. This is a rare case of CAPS presenting as non-specific abdominal pain following warfarin discontinuation...Figure: Figures 1A-C: Initial CT A/P of the liver reveals an enlarged spleen and gastric distention without evidence of infarction​.Figures 1D-F: Repeat CT A/P imaging done after APS flare-up, four days after initial presentation. Multiple new hypoattenuating lesions in the liver are visible, consistent with multiple infarcts.Figure: Figures 2A-2C: Esophagogastroduodenoscopy to work up gastric distension showed diffuse inflammation indicating gastritis in the body and upper body of the stomach (2A, 2B), with scattered gastric purpura in the antrum (2C)."

Clinical • Acute Kidney Injury • Cardiovascular • Complement-mediated Rare Disorders • Gastrointestinal Disorder • Genetic Disorders • Hematological Disorders • Hepatology • Immunology • Inflammation • Inflammatory Arthritis • Ischemic stroke • Nephrology • Pain • Peptic Ulcer • Renal Disease • Rheumatoid Arthritis • Rheumatology • Thrombocytopenia • Thrombosis