Comparing Voriconazole and Itraconazole in Treating Chronic Pulmonary Aspergillosis
|
Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
|
Posted on April 10th, 2026
|
Chronic pulmonary infection with the Aspergillus fumigatus fungus imposes a heavy burden in developing tropical nations like Vietnam and India. The condition is treatable with a 6 to 12 month regimen of oral azole antifungal. Voriconazole is favored due to its high bioavailability, but itraconazole is also viable due to its affordability and better safety profile. To better understand what would be the optimal treatment option, a study was conducted to compare voriconazole to itraconazole in treating chronic pulmonary aspergillosis.
Funding Source(s): Cipla Pharmaceuticals, India
The clinical study was conducted in India, and it included 116 participants with an average of 46 years old, who had been diagnosed with chronic cavitary pulmonary aspergillosis or chronic
fibrosing pulmonary aspergillosis. These patients were presented with one or more persistent cough, recurrent haemoptysis, weight loss, malaise, fever, or dyspnoea for at least 3 months. Chest CT was also conducted and found that the patients have around 2 to 3 cavities; all of them had pleural thickening, and fungal ball was detected in around three quarters of the patients. Serum antibody analysis found that the patients have around 90 mgA/L of IgG antibodies targeting Aspergillus fumigatus.
The patients were randomly assigned to be treated with either oral itraconazole or oral voriconazole for 6 months; both were given twice a day at 200 mg. After 6 months of treatment, the researchers found that both voriconazole and itraconazole were equally effective in reducing the symptoms and improving the radiological outcome of patients with chronic pulmonary aspergillosis. Follow-up at 12 months after treatment initiation found that the rate of disease relapse is similar between two groups at around 20%. However, usage of voriconazole is associated with a higher frequency of elevated liver enzyme, mucositis, and skin hyperpigmentation. This elevated risk of adverse events following voriconazole is consistent with previous findings. The researchers concluded that itraconazole should be used as the first-line therapy due to its lower cost and better tolerability, and voriconazole should be utilized as a second-line treatment.
Funding Source(s): Cipla Pharmaceuticals, India
The clinical study was conducted in India, and it included 116 participants with an average of 46 years old, who had been diagnosed with chronic cavitary pulmonary aspergillosis or chronic
fibrosing pulmonary aspergillosis. These patients were presented with one or more persistent cough, recurrent haemoptysis, weight loss, malaise, fever, or dyspnoea for at least 3 months. Chest CT was also conducted and found that the patients have around 2 to 3 cavities; all of them had pleural thickening, and fungal ball was detected in around three quarters of the patients. Serum antibody analysis found that the patients have around 90 mgA/L of IgG antibodies targeting Aspergillus fumigatus.
The patients were randomly assigned to be treated with either oral itraconazole or oral voriconazole for 6 months; both were given twice a day at 200 mg. After 6 months of treatment, the researchers found that both voriconazole and itraconazole were equally effective in reducing the symptoms and improving the radiological outcome of patients with chronic pulmonary aspergillosis. Follow-up at 12 months after treatment initiation found that the rate of disease relapse is similar between two groups at around 20%. However, usage of voriconazole is associated with a higher frequency of elevated liver enzyme, mucositis, and skin hyperpigmentation. This elevated risk of adverse events following voriconazole is consistent with previous findings. The researchers concluded that itraconazole should be used as the first-line therapy due to its lower cost and better tolerability, and voriconazole should be utilized as a second-line treatment.