MSG-15: Super-Bioavailability Itraconazole Versus Conventional Itraconazole in the Treatment of Endemic Mycoses—A Multicenter, Open-Label, Randomized Comparative Trial

• Published in: Open forum infectious diseases 2024-03, Vol.11 (3), p.ofae010-ofae010
• Main Authors: Spec, Andrej, Thompson, George R, Miceli, Marisa H, Hayes, Justin, Proia, Laurie, McKinsey, David, Arauz, Ana Belen, Mullane, Kathleen, Young, Jo-Ann, McGwin, Gerald, McMullen, Rachel, Plumley, Tyler, Moore, Mary K, McDowell, Lee Ann, Jones, Carolynn, Pappas, Peter G
• Format: Article
• Language: English
• Subjects: Diagnostic Methods and Tools; Editor's Choice
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofae010

Abstract Background Invasive fungal disease caused by dimorphic fungi is associated with significant morbidity and mortality. Super-bioavailability itraconazole (SUBA-itra) is a novel antifungal agent with pharmacokinetic advantages over currently available formulations. In this prospective comparative study, we report the outcomes of patients with endemic fungal infections (histoplasmosis, blastomycosis, coccidioidomycosis, and sporotrichosis). Methods This open-label randomized trial evaluated the efficacy, safety, and pharmacokinetics SUBA-itra compared with conventional itraconazole (c-itra) treatment for endemic fungal infections. An independent data review committee determined responses on treatment days 42 and 180. Results Eighty-eight patients were enrolled for IFD (SUBA-itra, n = 42; c-itra, n = 46) caused by Histoplasma (n = 51), Blastomyces (n = 18), Coccidioides (n = 13), or Sporothrix (n = 6). On day 42, clinical success was observed with SUBA-itra and c-itra on day 42 (in 69% and 67%, respectively, and on day 180 (in 60% and 65%). Patients treated with SUBA-itra exhibited less drug-level variability at days 7 (P = .03) and 14 (P = .06) of randomized treatment. The concentrations of itraconazole and hydroxyitraconazole were comparable between the 2 medications (P = .77 and P = .80, respectively). There was a trend for fewer adverse events (AEs; 74% vs 87%, respectively; P = .18) and serious AEs (10% vs 26%; P = .06) in the SUBA-itra–treated patients than in those receiving c-itra. Serious treatment-emergent AEs were less common in SUBA-itra–treated patients (12% vs 50%, respectively; P < .001). Conclusions SUBA-itra was bioequivalent, well tolerated, and efficacious in treating endemic fungi, with a more favorable safety profile than c-itra. Clinical Trials Registration NCT03572049. Itraconazole is the mainstay therapy for endemic mycoses. Unfavorable pharmacokinetics lead to subtherapeutic levels and adverse effects. Super-bioavailability itraconazole is bioequivalent to conventional itraconazole, with similar clinical outcomes, but has fewer adverse events, possibly owing to lower drug-level variability.