Efficacy and safety of isavuconazole versus voriconazole for the treatment of invasive aspergillosis: a systematic review and meta-analysis
Year: 2026
Type: article
Abstract: Isavuconazole has been recommended for the treatment of invasive aspergillosis (IA), but its comparative efficacy and safety versus voriconazole remain inconclusive due to limitations in previous meta-analysis. This study aims to systematically evaluate the effects of isavuconazole versus voriconazole for IA. The databases including PubMed, Embase, Web of Science, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Medical Database, VIP Database and Sinomed were searched to identify studies comparing isavuconazole with voriconazole for IA from inception to January 15, 2026. Data on overall response rate (ORR, defined as complete or partial response per study criteria), all-cause mortality (ACM), drug-related adverse reactions (ADR), galactomannan (GM) test, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were extracted. The meta-analysis was performed using RevMan 5.4 software. Seven studies involving 587 patients were included, comprising 4 randomized controlled trials (RCTs) and 3 cohort studies. The meta-analysis results showed no statistically significant differences between the two groups in ORR (RR = 1.11, 95% CI: 0.99 to 1.24, p = 0.07) and ACM (RR = 0.94, 95% CI: 0.69 to 1.28, p = 0.67). However, isavuconazole treatment significantly reduced the levels of GM (MD = -0.32, 95% CI: -0.4 to -0.21, p < 0.00001), TNF-α (MD = -9.18, 95% CI: -12.68 to -5.67, p < 0.00001) and IL-6 (MD = -3.87, 95% CI: -5.72 to -2.01, p < 0.0001). Furthermore, isavuconazole significantly decreased the incidence of ADR (RR = 0.44, 95% CI: 0.30 to 0.67, p = 0.0001), particularly hepatotoxicity (RR = 0.42, 95% CI: 0.1 to 0.96, p = 0.04). This meta-analysis shows no difference between isavuconazole and voriconazole in ORR or ACM for IA, but isavuconazole is associated with lower hepatotoxicity risk. Therefore, isavuconazole offers comparable efficacy with a potentially more favorable safety profile, and may be considered an alternative in patients at risk of hepatotoxicity. Not applicable.
Source: BMC Infectious Diseases
Authors: Qiang Yang, Lin Yuan, Xunyan Zhang, Pingxiu Tang
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7223466859
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