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Information relating to specific disease areas aligned to Pfizer’s portfolio and other resources designed for Pfizer medicines.

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Information on how to access prescribing information and adverse event reporting can be found at the bottom of the page.

Invasive fungal infections
and COVID-19

An emerging association

Invasive aspergillosis and mucormycosis represent a serious additional threat to COVID-19 patients who develop ARDS or are admitted to the ICU.1–5 Cases of COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) are increasingly being reported,6 with an overall prevalence among ICU patients of 9.3%7 and 1.6%8, respectively.

How many critically ill patients develop invasive aspergillosis in the ICU?​​​​​​​a

a. Cases of invasive aspergillosis (mainly pulmonary) reported among ICU patients in different prospective and retrospective studies. 

When to suspect

Some potential risk factors predisposing COVID-19 patients to secondary invasive fungal infections have been identified:1,7,8,15–18

  • ​​​​​​​​​​​​Use of corticosteroids
  • Widespread use of broad-spectrum antibiotics in the ICU
  • Immune dysregulation associated with COVID-19​​​
  • Presence of comorbidities, particularly those causing structural lung damage
  • Trauma, diabetes mellitus, haemopoietic malignancy, prolonged neutropenia, patients undergoing HSCT/SOT

Risk factors for invasive fungal infections in the ICU

Considerations when treating

Effective management of CAPA and CAM requires prompt diagnosis, treatment of underlying diseases, and aggressive medical intervention.1,19-21 However, clinical and radiological signs of CAPA and CAM can overlap – and there have been reports of simultaneous mixed superinfection – which may complicate the diagnosis.5,6,22

While there are several approved treatments for invasive aspergillosis and mucormycosis, an individualised assessment should be considered for every patient, taking into account differences in coverage, tolerability, drug interaction profile, and PK.23-26

CRESEMBA® (isavuconazole) is recommended by the ECMM for the treatment of CAPA and CAM27,28

CRESEMBA® is indicated in adults for the treatment of:23
  • • Invasive aspergillosis
  • • Mucormycosis in patients for whom amphotericin B is inappropriate
Consideration should be given to official guidance on the appropriate use of antifungal agents.

Key facts

  • Cases of CAPA and CAM are increasingly being reported:6 overall prevalence among ICU patients is 9.3%7 and 1.6%8, respectively
  • Mortality rate of CAPA and CAM in ICU patients with COVID-19 is ~50%7,8,29,30  
  • Effective management of CAPA and CAM requires prompt diagnosis and treatment1,19-21

Why choose CRESEMBA® (isavuconazole)?

  • An effective, guidelines-endorsed antifungal therapy21,23,27,28,31,32
  • In the SECURE registration trial, both survival and overall response rates were non-inferior to voriconazole33
  • Better tolerated than voriconazole, with fewer drug-related AEs (42% [n=109] vs 60% [n=155], p<0.001) and drug-related events leading to discontinuation (8% [n=21] vs 14% [n=35])33
  • Fewer drug–drug interactions than other azoles23,34
  • Simple and reliable dosing with a linear PK profile (up to 600 mg per day), unlike other azoles23,35,36
  • May be used in patients with renal impairment or mild-to-moderate hepatic impairment without dose adjustments23,a

CRESEMBA® can offer the flexibility you need, so that you can focus on your patient’s underlying condition23,33,34,37

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Safety Profile

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Support & Resources

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a. CRESEMBA® has not been studied in severe hepatic impairment; use in these patients is not recommended unless the potential benefit outweighs the risks (and these patients should be carefully monitored for potential drug toxicity)23

AEs, adverse events; ARDS, acute respiratory distress syndrome; CAM, COVID-19-associated mucormycosis; CAPA, COVID-19-associated pulmonary aspergillosis; COVID-19, coronavirus disease 2019; ECMM, European Confederation of Medical Mycology; HSCT, haematopoietic stem cell transplantation; ICU, intensive care unit; PI, Prescribing Information; PK, pharmacokinetics; SOT, solid organ transplantation. 
​​​
Prescribing Information
Click here for CRESEMBA® (isavuconazole) and Vfend (voriconazole) prescribing information

References:
​​​​​​​
1.  Arastehfar A, et al. J Fungi (Basel) 2020;6(2):91.
2.  Alanio A, et al. Lancet Respir Med 2020;8(6):e48–e49.
3.  Rutsaert L, et al. Ann Intensive Care 2020;10(1):71.
4.  Song G, et al. Mycopathologia 2020;185(4):599–606.
5.  Hoenigl M, et al. SSRN. 2021. [Epub ahead of print]. Available at: https://ssrn.com/abstract=3844587 or http://dx.doi.org/10.2139/ssrn.3844587.
6.  Benhadid-Brahmi Y, et al. JMM 2022;32(1):101231.
7.  Verweij PE, et al. Intensive Care Med 2021;47(8):819–834. 
8.    Patel A, et al. Emerg Infect Dis 2021;27(9):2349–2359.
9.     Schauwvlieghe AFAD, et al. Lancet Respir Med 2018;6(10):782–792.
10.   Wauters J, et al. Intensive Care Med 2012;38(11):1761–1768.
11.   Gustot T, et al. J Hepatol 2014;60(2):267–274.
12.   Delsuc C, et al. Crit Care 2015;19:421. 
13.   Contou D, et al. Ann Intensive Care 2016;6(1):52.
14.   Levesque E, et al. Ann Intensive Care 2019;9(1):31.
15.   Sharma S, et al. J Laryngol Otol 2021;135(5):442–447.
16.   Khatri A, et al. J Mycol Med 2021;31(2):101125.
17.   Mehta S and Pandey A. Cureus 2020;12(9):e10726.
18.   Ahmadikia K, et al. Mycoses 2021;64(8):798–808.
19.   do Monte Junior ES, et al. Clin Endosc 2020;53(6):746–749.
20.   Sen M, et al. Indian J Ophthalmol 2021;69(2):244–252.
21.   Ullmann AJ, et al. Clin Microbiol Infect 2018;24(Suppl 1):e1–e38. 
22.   Garg D, et al. Mycopathologia 2021;186:289–298.
23.   CRESEMBA GB Summary of Product Characteristics 2021.
24.   AmBisome Summary of Product Characteristics.
25.   Noxafil Summary of Product Characteristics.
26.   VFEND GB Summary of Product Characteristics.
27.   Koehler P, et al. Lancet Infect Dis 2021;21(6):e149–e162.
28.   Rudramurthy SM, et al. Mycoses 2021;64(9):1028–1037.
29.   Chong WH and Neu KP. J Hosp Infect 2021;113:115–129.
30.   John TM, et al. J Fungi (Basel) 2021;7(4):298.
31.   Tissot F, et al. Haematologica 2017;102(3):433-444. 
32.   Patterson TF, et al. Clin Infect Dis 2016;63(4):e1–e60.
33.   Maertens JA, et al. Lancet 2016;387(10020):760–769.
34.   Natesan SK and Chandrasekar PH. Infect Drug Resist 2016;9:291–300.
35.   Kaindl T, et al. J Antimicrob Chemother 2018:74(3):761–767.
36.   Schmitt-Hoffmann A, et al. Antimicrob Agents Chemother 2006;50(1):279–285.
37.   Perfect JR. Nat Rev Drug Discov 2017;16(9):603–616.
PP-CRB-GBR-1556. May 2022

ICU

  • Invasive fungal infections in the ICU
  • Invasive fungal infections and influenza

Meet Anika, our hypothetical ICU patient with suspected COVID-19-associated invasive aspergillosis

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Meet Sanjay, our hypothetical ICU patient with suspected COVID-19-associated mucormycosis

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PP-PFE-GBR-3863. November 2021

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