Patients with IDH1-mutated relapsed/refractory acute myeloid leukemia (AML) usually are treated with the IDH1 inhibitor ivosidenib. However, patients with AML and myelodysplastic syndromes (MDS) are at increased risk of fungal infections and are frequently given triazole antifungal medications, such as posaconazole and voriconazole.
To study possible drug-drug interactions, researchers led by Caitlin Rausch, Pharm.D., and Ashley Dinh, Pharm.D., evaluated serum triazole levels in 78 samples from 31 patients receiving ivosidenib-containing therapy in combination with posaconazole and voriconazole. They discovered median triazole levels were significantly reduced during ivosidenib treatment compared to off-treatment samples. Based on the findings, the researchers recommend therapeutic drug monitoring for all patients receiving a triazole antifungal with ivosidenib. They further suggest voriconazole should be avoided, if possible, with empiric high-dose posaconazole as a potential alternative to overcome this drug-drug interaction.