SUBA-itraconazole in the treatment of systemic fungal infections
Creators: name: Liu, Jennifer
name: Vanderwyk, Kees A
name: Donnelley, Monica A
name: Thompson, George R
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: Pharmacology
subject: Biotechnology
subject: Environmental Sciences not elsewhere classified
subject: Chemical Sciences not elsewhere classified
subject: Ecology
subject: Cancer
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Virology
subject: Computational Biology

description: Conventional itraconazole (c-ITZ) can be used for a variety of fungal infections although variable absorption has been a significant limitation. Super-bioavailable itraconazole (SUBA-ITZ) is a novel formulation that overcomes absorption concerns by utilizing a polymer-matrix to disperse active drug and facilitate dissolution. The pH-driven matrix allows concurrent proton pump inhibitor administration without significant effects on drug concentrations. The enhanced bioavailability of SUBA-ITZ allows for lower dosing, while achieving similar serum concentrations as c-ITZ and SUBA-ITZ is now US FDA approved in the treatment of blastomycosis, histoplasmosis and aspergillosis. Common side effects of SUBA-ITZ include gastrointestinal disorders, peripheral edema and drug-induced hypertension. Given the significant differences in pharmacokinetics between the formulations, c-ITZ and SUBA-ITZ capsules are not considered interchangeable. It is important to note that drug errors may occur when transitioning a patient from one formulation to another. Itraconazole is an antifungal agent used in the treatment of a number of mycoses. Prior formulations (versions) of itraconazole required strict dietary requirements and often had poor absorption. A new itraconazole formulation has since been developed – super bioavailable itraconazole (SUBA-itraconazole). This has no food requirements, has superior absorption and maintains effectiveness against a number of fungal infections. Conventional itraconazole (c-ITZ) suffers from poor absorption and tolerability and new antifungal options are urgently needed. A new formulation (SUBA-itraconazole) of itraconazole is now commercially available. SUBA-itraconazole is approved in the treatment of blastomycosis, histoplasmosis and aspergillosis. Off-label use is not uncommon in the treatment of other fungal diseases previously treated with c-ITZ and efficacy has been demonstrated in the treatment of dermatophytosis. Limited data has been presented in the treatment of pediatric patients, yet SUBA-itraconazole appears effective in this group of patients often excluded from clinical trials. SUBA-itraconazole has been evaluated in several studies for use as antifungal prophylaxis in immunosuppressed populations (hematopoietic stem cell transplant and lung transplant recipients). SUBA-itraconazole has the same spectrum of activity of c-ITZ. (SUBA-itraconazole) of itraconazole is now commercially available with improved pharmacokinetics and has no food or acid requirements for absorption. SUBA-itraconazole was compared with the conventional formulation in a head to head study and fewer adverse events were seen in patients treated with SUBA-itraconazole.