Real-World Antifungal Therapy Patterns Across the Continuum of Care in United States Adults with Invasive Aspergillosis

Changes to antifungal therapy (AFT) in invasive aspergillosis (IA) may occur due to intolerance, side effects, drug interactions, or lack of response. We describe AFT change patterns in IA patients. This was a US claims data study. IA patients were identified during the index hospitalization from October 2015 to November 2022. Patients were stratified by whether they 'changed' or 'did not change' AFT during or after the index hospitalization. AFT patterns were assessed for four lines of therapy or until loss of follow-up. First-line AFT began during the index hospitalization. Discontinuation with restart, modification, or switch in AFT ended the current line and initiated a subsequent line. Inverse probability-of-treatment weighting was utilized. Among 1192 adults with IA, 59.3% changed their AFT (60.0% modified AFT, 22.1% stopped first-line AFT and later initiated a new AFT for second line, and 18% immediately switched to a different AFT). Among those who changed AFT, triazole use predominated, with voriconazole (37.3-49.3%) and isavuconazole (19.3-26.7%) the most used across all AFT lines. Echinocandin use varied between 25.3 and 33.6% over all lines, and amphotericin B use increased over lines 1-4 (13.4-20.7%). Among the 40.7% of patients that completed AFT without changes, most received triazole monotherapy (62.8% voriconazole; 15.2% isavuconazole). Most patients required changes to their AFT.