How Does Ivosidenib Affect Triazole Levels in Patients With AML, MDS?

Caitlin Rausch, PharmD, a pharmacist in the leukemia department at The University of Texas MD Anderson Cancer Center, discusses the role of ivosidenib treatment in triazole levels in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) who are also receiving azole antifungals such as voriconazole and posaconazole.

Ivosidenib can increase the metabolism of these antifungal medications, according to Dr. Rausch.

“Anecdotally, we’re seeing low levels of antifungals, particularly voriconazole, in these patients beginning to use ivosidenib,” she said. “We wanted to look more closely to see if there was a true interaction.”

The researchers retrospectively reviewed azole levels in 31 patients receiving ivosidenib, and found that a significant number of patients had reduced levels of voriconazole and posaconazole.

“We have concluded that if you want to use an antifungal while the patient is receiving ivosidenib, you should probably avoid voriconazole because so many of our patients had undetectable or low levels,” Dr. Rausch said. “Posaconazole would be the preferred agent in this setting.”