CASE REPORT article
Front. Med.
Sec. Nephrology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1625697
Unexpected renal influence on isavuconazole trough concentrations : two case reports and literature review
Provisionally accepted
Hui Li
Xiaoshuang He
Qiuya LuLing WangJieling Jiang
Wenhui GaoLining Wang
Jiong Hu*
Jie Fang*
Xiaolan Bian*- Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Isavuconazole (ISA) is a first-line treatment for invasive aspergillosis, with routine therapeutic drug monitoring (TDM) typically deemed unnecessary. Although drug label and prior studies suggest renal function does not affect ISA pharmacokinetics, our findings in two high-risk patients challenge this perspective, showing an inverse correlation between ISA trough concentrations and estimated glomerular filtration rate (eGFR). Trough concentrations exceeding reported toxicity threshold were associated with adverse drug reactions(ADRs). Given the limited sample size, large-scale retrospective and prospective studies are urgently needed to confirm the impact of renal function on ISA and to develop individualized TDM strategies that optimize efficacy and minimize toxicity.
Keywords: invasive aspergillosis, Isavuconazole, Therapeutic drug monitoring, Renal function, adverse drug reactions
Received: 12 May 2025; Accepted: 25 Jul 2025.
Copyright: © 2025 Li, He, Lu, Wang, Jiang, Gao, Wang, Hu, Fang and Bian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jiong Hu, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Jie Fang, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Xiaolan Bian, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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