Isavuconazonium sulfate, sold under the brand name Cresemba, is a systemic antifungal medication of the

triazole A triazole is a heterocyclic compound featuring a five-membered ring of two carbon atoms and three nitrogen atoms with molecular formula C2H3N3. Triazoles exhibit substantial isomerism, depending on the positioning of the nitrogen atoms within th ...

class which is used to treat invasive

aspergillosis Aspergillosis is a fungal infection of usually the lungs, caused by the genus '' Aspergillus'', a common mould that is breathed in frequently from the air around, but does not usually affect most people. It generally occurs in people with lung di ...

and mucormycosis. The most common side effects include abnormal liver tests, nausea, vomiting, difficulty breathing, abdominal pain, diarrhea, injection site reactions, headache, low blood potassium and skin rash. Isavuconazonium is a prodrug of isavuconazole.

Medical uses

Isavuconazonium is used to treat invasive

and invasive mucormycosis in adults aged eighteen years old and older. It is available in a capsule for administration by mouth and as a powder for administration via infusion.

Contraindications

Isavuconazonium is contraindicated in people taking strong CYP3A4 inhibitors, strong CYP3A4 inducers, or moderate CYP3A4 or CYP3A5 inducers. It is contraindicated in people with familial short QT syndrome.

Side effects

Common adverse effects (occurring in between 1 and 10% of people) include low potassium, decreased appetite, delirium, headache, sleepiness, vein inflammation, difficulty breathing, acute respiratory failure, vomiting, diarrhea, nausea, stomach pain, elevated results in

liver function tests Liver function tests (LFTs or LFs), also referred to as a hepatic panel, are groups of blood tests that provide information about the state of a patient's liver. These tests include prothrombin time (PT/INR), activated partial thromboplastin t ...

, rash, itchy skin, kidney failure, chest pain, and fatigue. There are several uncommon side effects as well. In preclinical studies, isavuconazonium caused birth defects in animals; it has not been tested in pregnant women.

Interactions

Isavuconazonium is converted into isavuconazole inside the body, and isavuconazole is a substrate for CYP3A4 or CYP3A5. Many other medications inhibit or induce those two enzymes, and isavuconazonium should not be administered with them. Inducers result in levels of isavuconazole that are too low and won't work, and inhibitors can cause high levels of isavuconazole which will in turn cause increased adverse events and toxicity. Likewise isavuconazonium can interfere with appropriate dosing of other drugs that are substrates for those enzymes. In addition, isavuconazole induces

CYP2B6 Cytochrome P450 2B6 is an enzyme that in humans is encoded by the ''CYP2B6'' gene. CYP2B6 is a member of the cytochrome P450 group of enzymes. Along with CYP2A6, it is involved with metabolizing nicotine, along with many other substances. Func ...

and can decrease the amount of drugs that are metabolized by the enzyme. Isavuconazole inhibits P-glycoprotein (P-gp), BCRP,

SLC22A2 Solute carrier family 22 member 2 (also termed ''OCT2'' or ''organic cation transporter-2'') is a protein that in humans is encoded by the ''SLC22A2'' gene In biology, the word gene (from , ; "...Wilhelm Johannsen coined the word gene to de ...

, and uridine diphosphate-glucuronosyltransferases, each of which remove drugs from circulation; isavuconazonium will increase the amount of drugs that are affected by those proteins and may increase their toxicities.

Pharmacology

After oral or intravenous (IV) administration, isavuconazonium is rapidly hydrolysed by

esterase An esterase is a hydrolase enzyme that splits esters into an acid and an alcohol in a chemical reaction with water called hydrolysis. A wide range of different esterases exist that differ in their substrate specificity, their protein structure ...

s in blood or the

gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans a ...

to the active form, isavuconazole. Isavuconazole works by inhibition of

lanosterol 14α-demethylase Lanosterol 14α-demethylase (CYP51A1) is the animal version of a cytochrome P450 enzyme that is involved in the conversion of lanosterol to 4,4-dimethylcholesta-8(9),14,24-trien-3β-ol. The cytochrome P450 isoenzymes are a conserved group of pr ...

, the

enzyme Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrate (chemistry), substrates, and the enzyme converts the substrates into different molecule ...

responsible for converting lanosterol to ergosterol by

demethylation Demethylation is the chemical process resulting in the removal of a methyl group (CH3) from a molecule. A common way of demethylation is the replacement of a methyl group by a hydrogen atom, resulting in a net loss of one carbon and two hydrogen ato ...

. The resulting depletion of ergosterol and buildup of lanosterol compromise the structure of the fungal

cell membrane The cell membrane (also known as the plasma membrane (PM) or cytoplasmic membrane, and historically referred to as the plasmalemma) is a biological membrane that separates and protects the interior of all cells from the outside environment (the ...

. Mammalian cells are resistant to demethylation inhibition by azoles, making the drug effects specific to fungi.

Chemistry

Isavuconazonium comprises an ''N''-(3-acetoxypropyl)-''N''-methylamino-carboxymethyl group linked through an ester moiety to the triazole nitrogen in isavuconazole. In the aquatic media of the body, the isavuconazole molecule is transformed into monohydrate

History

Isavuconazole and isavuconazonium were discovered in Japan by researchers at Roche's research center in

Kamakura is a city in Kanagawa Prefecture, Japan. Kamakura has an estimated population of 172,929 (1 September 2020) and a population density of 4,359 persons per km² over the total area of . Kamakura was designated as a city on 3 November 1939. Kama ...

. Basilea Pharmaceutica, which had been spun out of Roche to develop antimicrobial assets, developed isavuconazonium through Phase II clinical trials. In February 2010, Basilea partnered with Astellas Pharma to complete Phase III trials, obtain regulatory approvals, and market the drug. In 2013 and 2014, the partners won orphan drug designation in the US for isavuconazonium for treating invasive aspergillosis, mucormycosis, and invasive candidiasis. In 2014, Basilea and Astellas amended the agreement to give Astellas sole marketing authority in North America, and Basilea the rights to market in the rest of the world. The U.S.

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

(FDA) granted approval in March 2015, and the European Medicines Agency (EMA) approved it in October 2015. Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged. In 2017, Basilea licensed rights to Pfizer to market isavuconazole in Europe and other regions.

References

External links

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