Voriconazole

Voriconazole (vor-i-KON-a-zole, brand name Vfend, Pfizer) is a triazole antifungal medication that is generally used to treat serious, invasive fungal infections. These are generally seen in patients who are immunocompromised, and include invasive candidiasis, invasive aspergillosis, and certain emerging fungal infections.

Indications

Invasive aspergillosis

Voriconazole has become the new standard of care in the treatment of invasive aspergillosis, which may occur in immunocompromised patients, including allogeneic BMT, hematologic cancers, and solid organ transplants. This is based on the results of a large, randomized study in which voriconazole proved superior to amphotericin B with 53% complete or partial response, compared with 32% for amphotericin B.

Importantly, voriconazole also offered a 22% greater survival benefit over amphotericin B, with 71% of voriconazole patients still alive at week 12. Only 13% of patients who received initial therapy with voriconazole died from invasive aspergillosis, compared with 29% of patients who initially received amphotericin B. Voriconazole was also better tolerated than amphotericin B, with significantly fewer serious adverse effects and a longer duration of therapy. Note that the design of these studies has been called into question, and some still consider (liposomal) amphotericin B as the drug of choice. For multiple site or CNS aspergillosis a combination therapy of voriconazole and caspofungin should be considered. It is also the recommended treatment for the CNS fungal infections transmitted by epidural injection of contaminated steroids.