Isavuconazole provides effective and tolerable antifungal prophylaxis for patients with acute myeloid leukemia.

Voriconazole has been a standard antifungal prophylactic (AFP) agent for patients with acute myeloid leukemia (AML) during neutropenia. However, its use is complicated by side-effects including transaminase elevations, visual disturbances, and significant drug-drug interactions (DDIs). Isavuconazole is an AFP agent with a more attractive side-effect profile. In a retrospective analysis we compared rates of complications necessitating AFP withdrawal between patients with AML who initially started on isavuconazole (n = 63) or voriconazole (n = 215), and of invasive fungal infection (IFI) and median overall survival (OS) between patients who used only isavuconazole (n = 41) or voriconazole (n = 90). Voriconazole was associated with higher rates of AFP discontinuation due to transaminase elevations (p = 0.019), visual disturbances (p = 0.002), or DDIs (p = 0.002), while isavuconazole was more frequently discontinued due to coverage denial/high cost (p < 0.0001). Rates/classification of IFI, breakthrough IFI (bIFI) and IFI-free survival (IFI-FS) were comparable between azoles in both analyses. Isavuconazole is an effective AFP agent with a superior side-effect profile and should thus be considered as a promising AFP option for patients with AML.