Voriconazole and posaconazole therapeutic drug monitoring: a retrospective study

Annals of Clinical Microbiology and Antimicrobials

Research

Robert MacLaren¹  Douglas N. Fish¹  Scott W. Mueller¹  Tyree H. Kiser²  Kelly E. Schoeppler³  Whitley M. Yi⁴  Jaclyn Jaeger⁴ 

[1] Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E Montview Blvd, 80045, Aurora, CO, USA;Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E Montview Blvd, 80045, Aurora, CO, USA;Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, C238, 12850 E Montview Blvd, 80045, Aurora, CO, USA;Department of Pharmacy, University of Colorado Hospital, 12605 E 16th Ave, 80045, Aurora, CO, USA;University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E Montview Blvd, 80045, Aurora, CO, USA;

关键词: Voriconazole;    Posaconazole;    Therapeutic drug monitoring;    Invasive fungal disease;   

DOI  :  10.1186/s12941-017-0235-8

 received in 2017-03-07, accepted in 2017-08-31,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundTherapeutic drug monitoring (TDM) aims to minimize the clinical impact of posaconazole and voriconazole pharmacokinetic variability. However, its benefits on clinical outcomes are still being defined. Additionally, TDM data are limited for posaconazole IV and delayed-release tablet formulations among specific patient populations, including critically ill. The aim of this study was to determine the percentage of therapeutic posaconazole and voriconazole drug levels across all formulations in a real-world clinical setting and elucidate factors affecting attainment of target concentrations.MethodsThis study was a retrospective cohort study conducted at the University of Colorado Hospital between September 2006 and June 2015 that evaluated patients who received posaconazole or voriconazole TDM as part of routine care.ResultsVoriconazole (n = 250) and posaconazole (n = 100) levels were analyzed from 151 patients. Of these, 54% of voriconazole and 69% of posaconazole levels were therapeutic. For posaconazole, 14/38 (37%), 28/29 (97%) and 27/33 (82%) levels were therapeutic for the oral suspension, IV, and delayed-release tablet, respectively. Intravenous and delayed-release tablet posaconazole were 20 fold (p < 0.01) and sevenfold (p = 0.002) more likely than the oral suspension to achieve a therapeutic level. Subsequent levels were more likely to be therapeutic after dose adjustments (OR 3.31; 95% CI 1.3–8.6; p = 0.02), regardless of timing of initial non-therapeutic level. In a multivariable logistic regression analysis, no characteristics were independently predictive of therapeutic voriconazole levels and only absence of H2RA/PPI use was independently predictive of therapeutic posaconazole levels. There was no correlation between survival and therapeutic drug levels for either voriconazole (p = 0.67) or posaconazole (p = 0.50).ConclusionsA high percentage of drug levels did not achieve TDM targets for voriconazole and posaconazole oral suspension, supporting the need for routine TDM for those formulations. The utility of TDM for the IV and delayed-release tablet formulations of posaconazole is less apparent.

【 授权许可】

CC BY   
© The Author(s) 2017