Hospital resource use of patients receiving isavuconazole vs voriconazole for invasive mold infections in the phase III SECURE trial

<p><b>Objective</b>: In the phase III SECURE trial, isavuconazole was non-inferior to voriconazole for all-cause mortality for the primary treatment of invasive mold disease (IMD) caused by <i>Aspergillus</i> spp. and other filamentous fungi. This analysis assessed whether hospital resource utilization was different between patients treated with isavuconazole vs voriconazole in SECURE. <b>Methods</b>: The analysis population comprised adults with proven/probable/possible IMD enrolled in SECURE. The primary endpoint was hospital length of stay (LOS) in the overall trial population. Patients were also stratified by estimated glomerular filtration rate-modification of diet in renal disease category (< 60 mL/min/1.73 m<sup>2</sup> [moderate-to-severe impairment] and ≥60 mL/min/1.73 m<sup>2</sup> [mild or no impairment]), body mass index (BMI; <25, ≥25–<30, and ≥30 kg/m<sup>2</sup>), and age (≤45, >45–≤65, and >65 years). <b>Results</b>: Data from 516 patients (258 per arm) were evaluated. Overall, median LOS was not statistically significantly different between the isavuconazole (15.0 days) and voriconazole (16.0 days; <i>p</i> = 0.607) arms. Median LOS was statistically significantly shorter in patients with moderate-to-severe renal impairment treated with isavuconazole (9.0 days) vs voriconazole (19.0 days; hazard ratio [HR]: 3.44; 95% confidence interval [CI] = 1.51–7.83). Median LOS was shorter, but not significantly, in patients with a BMI ≥30 kg/m<sup>2</sup> (isavuconazole 13.5 days vs voriconazole 22 days; HR = 1.57; 95% CI = 0.70–3.52) or aged >65 years (isavuconazole 15.0 days vs voriconazole 20.0 days; HR = 1.37; 95% CI = 0.87–2.16). <b>Limitations</b>: As the patient subgroups analyzed were small, sub-group findings should be interpreted with caution in light of the lack of statistical significance for each sub-group-by-treatment interaction. <b>Conclusions</b>: Isavuconazole may reduce hospital LOS in certain subgroups of patients with IMD, especially those with moderate-to-severe renal impairment.</p>