TY - JOUR
T1 - Clinical usefulness of therapeutic drug monitoring of voriconazole in a university hospital
AU - Cabral-Galeano, Evelyn
AU - Ruiz-Camps, Isabel
AU - Len-Abad, Oscar
AU - Pou-Clavé, Leonor
AU - Sordé-Masip, Roger
AU - Meije-Castillo, Yolanda
AU - Blanco-Grau, Albert
AU - Barba-Suñol, Pere
AU - Monforte-Torres, Victor
AU - Román-Broto, Antonio
AU - Pahissa-Berga, Albert
AU - Gavaldà-Santapau, Joan
PY - 2015/1/1
Y1 - 2015/1/1
N2 - © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Introduction The aim of this study was to assess the clinical usefulness of therapeutic drug monitoring (TDM) of voriconazole (VOR) in a university hospital. Methods A retrospective review was conducted on the clinical records of 52 patients treated with VOR and on whom TDM was performed. Steady-state trough plasma VOR concentration was measured at least 5 days after starting treatment. The therapeutic range of plasma VOR concentration was defined as 1-5.5 μg/mL. Results The most frequent underlying conditions in the study population were lung transplant (48.1%) and hematological malignancies (26.9%). At the first TDM in each patient, VOR levels were outside the therapeutic range in 16 (30.7%) cases: <1 μg/mL in 10 (19.2%) and >5.5 μg/mL in 6 (11.5%). Eleven patients (21.2%) experienced severe muscle weakness and had considerable difficulty walking. All these patients were receiving concomitant treatment with corticosteroids. Age younger than 30 years (p =.005) and cystic fibrosis as the underlying disease (p =.04) were factors associated with low VOR levels. Almost all patients who had VOR concentrations >1 μg/mL at the first TDM had a successful outcome (96%). Conclusions Plasma VOR concentrations were outside the therapeutic range at the first TDM in 30% (16/52) of patients. Age younger than 30 years and cystic fibrosis were factors associated with low VOR levels. The potential interactions between corticosteroids and VOR should be highlighted, as they could be responsible for a high rate of muscle weakness observed in our patients. Prospective trials are needed to investigate VOR TDM and corticosteroid pharmacokinetics.
AB - © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Introduction The aim of this study was to assess the clinical usefulness of therapeutic drug monitoring (TDM) of voriconazole (VOR) in a university hospital. Methods A retrospective review was conducted on the clinical records of 52 patients treated with VOR and on whom TDM was performed. Steady-state trough plasma VOR concentration was measured at least 5 days after starting treatment. The therapeutic range of plasma VOR concentration was defined as 1-5.5 μg/mL. Results The most frequent underlying conditions in the study population were lung transplant (48.1%) and hematological malignancies (26.9%). At the first TDM in each patient, VOR levels were outside the therapeutic range in 16 (30.7%) cases: <1 μg/mL in 10 (19.2%) and >5.5 μg/mL in 6 (11.5%). Eleven patients (21.2%) experienced severe muscle weakness and had considerable difficulty walking. All these patients were receiving concomitant treatment with corticosteroids. Age younger than 30 years (p =.005) and cystic fibrosis as the underlying disease (p =.04) were factors associated with low VOR levels. Almost all patients who had VOR concentrations >1 μg/mL at the first TDM had a successful outcome (96%). Conclusions Plasma VOR concentrations were outside the therapeutic range at the first TDM in 30% (16/52) of patients. Age younger than 30 years and cystic fibrosis were factors associated with low VOR levels. The potential interactions between corticosteroids and VOR should be highlighted, as they could be responsible for a high rate of muscle weakness observed in our patients. Prospective trials are needed to investigate VOR TDM and corticosteroid pharmacokinetics.
KW - Aspergillosis
KW - Drug interaction
KW - Tacrolimus
KW - Therapeutic drug monitoring
KW - Voriconazole
U2 - 10.1016/j.eimc.2014.09.005
DO - 10.1016/j.eimc.2014.09.005
M3 - Article
VL - 33
SP - 298
EP - 302
JO - Enfermedades Infecciosas y Microbiologia Clinica
JF - Enfermedades Infecciosas y Microbiologia Clinica
SN - 0213-005X
IS - 5
ER -