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Voriconazole is the current standard therapy for invasive aspergillosis. However, its use is limited by toxicity, pharmacokinetic variability, and concern about its intravenous vehicle, β-cyclodextrin. Recently, isavuconazonium sulfate, a water-soluble prodrug of the triazole antifungal isavuconazole, was FDA-approved for use in patients with invasive aspergillosis and mucormycosis. The manufacturers of isavuconazole have funded an international, phase III, randomized, double-blind, noninferiority trial comparing voriconazole with isavuconazole in patients with proven, probable, or possible invasive mold disease. The primary endpoint was mortality from any cause at day 42.
Of 516 patients in the intention-to-treat analysis, more than 80% had…