Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Oct 15;79(4):936-943.
doi: 10.1093/cid/ciae371.

European Study of Cerebral Aspergillosis treated with Isavuconazole (ESCAI): A study by the ESCMID Fungal Infection Study Group

Alexandra Serris  1 , Riina Rautemaa-Richardson  2   3 , Joana D Laranjinha  4 , Anna Candoni  5 , Carolina Garcia-Vidal  6 , Ana Alastruey-Izquierdo  7   8 , Helena Hammarström  9   10 , Danila Seidel  11   12 , Jan Styczynski  13 , Raquel Sabino  14   15 , Frederic Lamoth  16   17 , Juergen Prattes  18 , Adilia Warris  19   20 , Raphaël Porcher  21   22 , Fanny Lanternier  1   23 ; ESCAI Study Group
Collaborators, Affiliations
Multicenter Study

European Study of Cerebral Aspergillosis treated with Isavuconazole (ESCAI): A study by the ESCMID Fungal Infection Study Group

Alexandra Serris et al. Clin Infect Dis. .

Abstract

Background: Cerebral aspergillosis (CA) is associated with high mortality. According to the European Conference on Infections in Leukemia and the European Society of Clinical Microbiology and Infectious Diseases guidelines, the recommended first-line treatment for all forms of aspergillosis is voriconazole or isavuconazole. However, little is known about the efficacy and safety of isavuconazole in CA.

Methods: We conducted a European multicenter retrospective study of patients treated with isavuconazole for proven or probable CA between 2014 and 2022 and compared the outcomes with those of weighted control groups from the previously published French national cohort of CA, the Cerebral Aspergillosis Lesional Study (CEREALS).

Results: Forty patients from 10 countries were included. The main underlying conditions were hematological malignancies (53%) and solid-organ transplantation (20%). Isavuconazole was administered as a first-line treatment to 10 patients, primarily in combination therapy, resulting in control of CA in 70% of these cases. Thirty patients received isavuconazole after a median of 65 days on another therapy, mostly because of side effects (50%) or therapeutic failure (23%) of the previous treatment. Predominantly given as monotherapy, it achieved control of CA in 73% of the patients. Seventeen patients (43%) underwent neurosurgery. When measured, isavuconazole levels were low in cerebrospinal fluid but adequate in serum and brain tissue. Isavuconazole toxicity led to treatment interruption in 7.5% of the patients. Twelve-week mortality was 18%. Comparison with the CEREALS cohort showed comparable survival in patients receiving isavuconazole or voriconazole as a first-line treatment.

Conclusions: Isavuconazole appears to be a well-tolerated treatment. Mortality of CA treated with isavuconazole is similar to that reported with voriconazole.

Keywords: brain infection; central nervous system aspergillosis; cerebral aspergillosis; invasive aspergillosis; isavuconazole.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. A. C.: honoraria from Novartis, Janssen, Pfizer, Gilead, Celgene, Incyte, AbbVie, Astellas. A. A.-I.: honoraria for educational talks on behalf of Gilead, Pfizer, Mundipharma, and MSD, outside the submitted work. H. H.: honoraria from Gilead, Sandoz, and Sanofi. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

References

Publication types

MeSH terms

LinkOut - more resources