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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 influenza

Influenza: an independent risk factor for invasive pulmonary aspergillosis1,2

Approximately 5–10% of patients who are hospitalised with influenza have been shown to end up in the ICU.2–4 Once in critical care, ~1 in 5 severe influenza patients have been shown to develop invasive aspergillosis.1,3,5 Influenza-associated pulmonary aspergillosis (IAPA) is a severe complication and may occur in any patient, including those considered to be at low risk of developing IPA.2

~20% incidence in patients with severe influenza​​​​​​​1,3,5

The median time between influenza diagnosis and IAPA is short, often in the first 5 days after ICU admission,5–7 and it has become clear that risk does not depend on the influenza subtype in this patient population.1
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A Dutch-Belgian multicenter study carried out over seven influenza seasons in seven institutes demonstrated that influenza is an independent risk factor for IPA (adjusted OR=5.19, 95% CI: 2.63–10.26, p<0.0001). Results also showed that the 90-day mortality rate for ICU patients with IAPA was almost double that of influenza patients without IAPA (51% vs 28%, adjusted OR=1.87, 95% CI: 1.05–3.32, p=0.0001).1,2

Patients who survived IAPA received antifungal therapy much earlier than those who did not (2 days after diagnosis of influenza among survivors vs 9 days among non-survivors).6 Cases of influenza-associated mucormycosis (IAM) are also emerging. A review found that the majority of these patients had underlying conditions, diabetes mellitus being the most common. Risk factors overlap with IAPA, which may contribute to cases of IAM being under-diagnosed or under-reported.8

Despite advances in diagnosis and treatment, invasive fungal infection mortality remains very high.9–13 Low clinical suspicion may cause potentially fatal delays in diagnosis and treatment,2,8 and early administration of antifungal therapy is of critical importance to improve clinical outcomes.14


Key facts

  • Once in the ICU, approximately 1 in 5 patients with severe influenza develop invasive aspergillosis1,3,5
  • The majority of IAM patients will have an underlying condition: diabetes mellitus is the most common8

Why choose CRESEMBA® (isavuconazole)?

  • An effective, guidelines-endorsed antifungal therapy15-20
  • In the SECURE registration trial, both survival and overall response rates were non-inferior to voriconazole21
  • 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])21
  • Fewer drug–drug interactions than other azoles9,20
  • Simple and reliable dosing with a linear PK profile (up to 600 mg per day), unlike other azoles20,22,23
  • May be used in patients with renal impairment or mild-to-moderate hepatic impairment without dose adjustments20,a
CRESEMBA® can offer the flexibility you need, so that you can focus on your patient’s underlying condition9,10,20,21
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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).20

AEs, adverse events; IAM, influenza-associated mucormycosis; IAPA, influenza-associated pulmonary aspergillosis; ICU, intensive care unit; IPA, invasive pulmonary aspergillosis; PK, pharmacokinetics.

                       
Prescribing Information
​​​​Click here for CRESEMBA® (isavuconazole) and Vfend (voriconazole) prescribing information

References:
  1. Schauwvlieghe AFAD, et al. Lancet Respir Med 2018;6(10):782–792.
  2. Verweij PE, et al. Intensive Care Med 2020;46(8):1524–1535.
  3. Vanderbeke L et al. Curr Opin Infect Dis 2018;31(6):471–480.
  4. GBD. 2017 Influenza Collaborators. Lancet Respir Med 2019;7:69–89.
  5. Wauters J, et al. Intensive Care Med 2012;38(11):1761–1768.
  6. van de Veerdonk FL, et al. Am J Respir Crit Care Med 2017;196:524–527.
  7. Ku YH, et al. J Formos Med Assoc 2017;116:660–670.
  8. Ahmadikia K, et al. Mycoses 2021;64(8):798–808.
  9. Natesan SK and Chandrasekar PH. Infect Drug Resist 2016;9:291–300.
  10. Perfect JR. Nat Rev Drug Discov 2017;16(9):603–616.
  11. Binder U and Lass-Florl C. Mediterr J Hematol Infect Dis 2011;3(1):e20110016.
  12. Low CY and Rotstein C. F1000 Med Rep 2011;3:14.
  13. Bassetti M and Bouza E. J Antimicrob Chemother 2017;72(Suppl 1):i39–i47.
  14. Koehler P, et al. Clin Microbiol Infect 2019;25(12):15011509.
  15. Tissot F, et al. Haematologica 2017;102(3):433-444.
  16. Ullmann AJ, et al. Clin Microbiol Infect 2018;24(Suppl 1):e1–e38.
  17. Patterson, TF et al. Clin Infect Dis 2016;63(4):e1–e60.
  18. Koehler P, et al. Lancet Infect Dis 2021;21(6):e149e162.
  19. Rudramurthy SM, et al. Mycoses 2021;64(9):10281037.​​​​​​​
  20. CRESEMBA GB Summary of Product Characteristics 2021.
  21. Maertens JA, et al. Lancet 2016;387(10020):760–769.
  22. Kaindl T, et al. J Antimicrob Chemother 2018:74(3):761–767.
  23. Schmitt-Hoffmann A, et al. Antimicrob Agents Chemother 2006;50(1):279–285.​​​​​​​
PP-CRB-GBR-1555. May 2022

ICU

  • Invasive fungal infections in the ICU
  • Invasive fungal infections and COVID-19

Meet Ruth, our hypothetical ICU patient with suspected invasive aspergillosis post influenza

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PP-PFE-GBR-3863. November 2021

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