Voriconazole Shows Better Short-Term Response than fluoconazole in Pulmonary Cryptococcosis: Study
Researchers have found in a new study that among patients of pulmonary cryptococcosis with initial treatment failures, switching to voriconazole produced significantly better short-term outcomes by day 60. However both drugs showed comparable long-term response rates by day 180 and adverse event rates were similar between the two groups. The study was published in BMC Infectious Diseases by Dian Y. and colleagues.
Fluconazole is used extensively because of its efficacy, tolerability, and oral availability. This multicenter, real-world retrospective study included patients with pulmonary cryptococcosis who had fluconazole treatment failure. Patients were grouped into two different regimens in antifungal management: continued fluconazole, as a control; and switching to voriconazole. The treatment responses were evaluated at the pre-defined time of day 60 and day 180, while safety outcomes were recorded for adverse reactions.
The first therapy with fluconazole was successful in 82.72% of the cases, confirming its effectiveness for the majority of them. In those where fluconazole failed, 34 patients were analyzed, where 19 patients were put in the group of continuation with fluconazole and the remaining 15 in the switch group with voriconazole. The baseline characteristics were similar between the groups, which allowed for an evaluation of treatment outcomes.
Key findings
The response to treatment at day 60 for the voriconazole group was significantly higher compared to the fluconazole group, with response rates of 66.67% (10 of 15 patients) versus 15.79% (3 of 19 patients), respectively (p = 0.002).
At day 180, response rates were comparable: 66.67% in the voriconazole group (10 of 15) vs 68.42% in the fluconazole group, 13 of 19 (p = 0.914).
During voriconazole treatment, the most common adverse reactions occurred in 20.00% of patients (3 of 15) compared with 15.79% in the fluconazole group (3 of 19), showing no statistical difference between treatments (p = 0.439).
Most patients with pulmonary cryptococcosis have a good response when initially treated with fluconazole. Among patients in whom fluconazole treatment failed, the strategy of switching to voriconazole had superior short-term efficacy compared with the strategy of continuing fluconazole. Long-term outcome and safety were similar between the two strategies.
Reference:
Yuan, D., Li, K., Zheng, X. et al. Effectiveness of voriconazole therapy for pulmonary cryptococcosis in fluconazole treatment failure: a multicenter real-world study. BMC Infect Dis 25, 1609 (2025). https://doi.org/10.1186/s12879-025-11985-1
