This type of fungal infection with a high fatality rate ushered in a new oral drug

Recently, an oral antifungal drug, isavuconazole sulfate capsules (English trade name: CRESEMBA, Chinese trade name: Kangxinbo), has been approved by the National Medical Products Administration of China (NMPA) for the treatment of adult invasive Mucor mold

According to public information, this is the first oral antifungal drug approved in mainland China for the treatment of invasive mucormycosis in adults, bringing a new treatment option for patients with this rare fungal infection with a high fatality rate

Fungal infections with a high fatality rate

Invasive fungal disease (IFD) refers to a disease characterized by pathophysiological changes such as inflammation, tissue damage and organ dysfunction after fungi invade the human body and grow and multiply in various tissues of the human body, including blood

Typical invasive fungal diseases include invasive candidiasis, invasive aspergillosis and invasive mucormycosis

Invasive mucormycosis usually occurs in people with compromised immune systems, such as people with AIDS, diabetes, cancer, and people taking immunosuppressants

Even more worrisome, for patients diagnosed with invasive mucormycosis, currently available treatment options are very limited, patients have a poor prognosis and high mortality

Epidemiology shows that the overall mortality rate of patients with invasive mucormycosis is close to 50%; the mortality rate of patients with hematological tumors, lung infections and involvement of the central system can reach 70%; and, if appropriate antifungal drugs are not provided in time, It will significantly increase the mortality of patients, and the mortality rate of delaying treatment for 12 weeks can reach 82.

Therefore, early diagnosis and treatment of high-risk groups of invasive mucormycosis such as hematological malignancies, solid and hematopoietic stem cell transplantation, use of glucocorticoids, diabetes and use of antifungal drugs for prevention, and patients with major trauma should be carried out as soon as possible

Oral triazole antifungals

Isavuconazole Sulfate Capsules is an oral triazole antifungal drug

Public information shows that isavuconazole sulfate capsules can inhibit the demethylation of 14α-lanosterol mediated by cytochrome P450 (CYP), so that the synthesis of ergosterol in the cell membrane of fungi is inhibited, and the toxic intermediate lanosterol is accumulated.

Compared with other azole drugs, the special molecular structure of isavuconazole sulfate capsules can orient the triazole ring to engage with the binding pocket of fungal CYP51 protein, thus giving it a broader antifungal spectrum, including azole-resistant drugs.

According to literature reports, Isavuconazole Sulfate Capsules have a broad antibacterial spectrum, and in vitro studies and clinical trials have shown that they have antibacterial activity against molds, yeasts, bidirectional fungi and some rare fungi; it is effective in the treatment of infections in special parts, such as the central nervous system.

Currently, multiple European guidelines have recommended isavuconazole as a first-line treatment for invasive aspergillosis in patients with hematological diseases

References

[1] Jiang Yingyu, Zhu Liping.

[2] China State Food and Drug Administration, December 16, Drug Approval Certificate Pending Information.

[4] Pfizer signs agreement to develop and sell CRESEMBA® (isavuconazole) in China and Asia Pacific.

(Original abridged)