{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:55:56Z","timestamp":1793094956916,"version":"4.5.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Triazoles (eg, isavuconazole, posaconazole, voriconazole) are the first-line treatment for invasive pulmonary aspergillosis (IPA), but their use can be limited by drug interactions, hepatotoxicity, and emerging azole resistance. Recent guidelines recommend echinocandins as a safe and well-tolerated first-line alternative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multicenter observational study across 9 treatment centers, we included all consecutive patients with IPA from 1 January 2014 to 1 June 2024. We compared 30-day overall survival (OS) as the primary outcome and 90-day OS as the secondary outcome between patients receiving triazoles versus echinocandins as first-line therapy. Propensity score adjustment was applied to address baseline characteristic imbalances.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 177 patients, of whom 153 (86%) received triazoles as first-line therapy (69 voriconazole, 54 isavuconazole, 30 posaconazole). Before propensity score adjustment, patients treated with echinocandins were significantly sicker, with higher rates of intensive care treatment (95% vs 75%, P = .002). In both crude and propensity score\u2013adjusted analyses, 30-day mortality was significantly higher in the echinocandin group compared to the triazole group (63% [95% CI 55\u201370] vs 30% [95% CI 13\u201350], P &amp;lt; .001). Even switching from echinocandins after initial treatment failure to salvage therapy did not mitigate the negative impact on OS. Switching from triazoles (28\/153 cases) was mainly due to tolerability concerns, while echinocandins (12 cases) were switched for treatment failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using echinocandins as alternative first-line treatment for IPA may result in poorer survival outcomes and should be approached with caution until further trials confirm our findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf709","type":"journal-article","created":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T12:58:33Z","timestamp":1763211513000},"source":"Crossref","is-referenced-by-count":5,"title":["Triazoles Versus Echinocandins for the First-Line Treatment of Invasive Pulmonary Aspergillosis: A Propensity Score\u2013Weighted Multicenter Study"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6266-0512","authenticated-orcid":false,"given":"Stefan","family":"Hatzl","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Intensive Care Unit, Medical University of Graz , Graz ,","place":["Austria"]},{"name":"BioTechMed-Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4918-1749","authenticated-orcid":false,"given":"Christina","family":"Geiger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, Medical University of Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-2196","authenticated-orcid":false,"given":"Lisa","family":"Kriegl","sequence":"additional","affiliation":[{"name":"BioTechMed-Graz , Graz ,","place":["Austria"]},{"name":"Department of Internal Medicine, Division of Infectious Diseases, Medical University of Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9333-7689","authenticated-orcid":false,"given":"Andreas","family":"Reinisch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology, Medical University of Graz , Graz ,","place":["Austria"]},{"name":"Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Keldorfer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care Unit, Medical University of Graz , Graz 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