Utility of voriconazole therapeutic drug monitoring: a
meta-analysis

J 2016

Utility of voriconazole therapeutic drug monitoring: a meta-analysis

LUONG, Me-Linh, Mona AL-DABBAGH, Andreas H. GROLL, Zdeněk RÁČIL, Yasuhito NANNYA et. al.

Základní údaje

Originální název

Utility of voriconazole therapeutic drug monitoring: a meta-analysis

Autoři

LUONG, Me-Linh (124 Kanada), Mona AL-DABBAGH (124 Kanada), Andreas H. GROLL (276 Německo), Zdeněk RÁČIL (203 Česká republika, garant, domácí), Yasuhito NANNYA (392 Japonsko), Dimitra MITSANI (840 Spojené státy) a Shahid HUSAIN (124 Kanada)

Vydání

Journal of Antimicrobial Chemotherapy, Oxford, Oxford University Press, 2016, 0305-7453

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30104 Pharmacology and pharmacy

Stát vydavatele

Velká Británie a Severní Irsko

Utajení

není předmětem státního či obchodního tajemství

Impakt faktor

Impact factor: 5.071

Kód RIV

RIV/00216224:14110/16:00089949

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.1093/jac/dkw099

UT WoS

000383246000005

Klíčová slova anglicky

INVASIVE FUNGAL-INFECTIONS; ADVERSE EVENTS; PLASMA-CONCENTRATIONS; BLOOD-CONCENTRATION; CLINICAL-OUTCOMES; EFFICACY; ASPERGILLOSIS; MULTICENTER; GUIDELINES; DISEASES

Štítky

EL OK

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 25. 10. 2016 10:45, Ing. Mgr. Věra Pospíšilíková

Anotace

V originále

Background: Voriconazole therapeutic drug monitoring (TDM) is increasingly used in clinical practice. However, the utility of voriconazole TDM to guide therapy remains uncertain and controversial. We conducted a metaanalysis of studies assessing the relationship between voriconazole serum concentration and clinical outcomes of success and toxicity. Methods: We searched bibliographic databases for studies on voriconazole serum concentrations and clinical outcomes. We compared success outcomes between patients with therapeutic and subtherapeutic voriconazole serum concentrations, and toxicity outcomes between patients with and without supratherapeutic serum concentrations. Results: Twenty-four studies were analysed. Pooled analysis for efficacy endpoint demonstrated that patients with therapeutic voriconazole serum concentrations (1.0–2.2 mg/L) were more likely to have successful outcomes compared with those with subtherapeutic voriconazole serum concentrations (OR 2.30; 95% CI 1.39–3.81). A therapeutic threshold of 1.0 mg/L was most predictive of successful outcome (OR 1.94; 95% CI 1.04–3.62). Patients with therapeutic concentrations did not have better survival rates. Pooled analysis for toxicity endpoint demonstrated that patients with supratherapeutic voriconazole serum concentrations (4.0–6.0 mg/L) were at increased risk of toxicity (OR 4.17; 95% CI 2.08–8.36). A supratherapeutic threshold of 6.0 mg/L was most predictive of toxicity (OR 4.60; 95% CI 1.49–14.16). Conclusions: Patients with therapeutic voriconazole serum concentrations were twice as likely to achieve successful outcomes. The likelihood of toxicity associated with supratherapeutic voriconazole serum concentrations was 4-fold that of therapeutic concentrations. Our findings suggest that the use of voriconazole TDM to aim for serum concentrations between 1.0 and 6.0 mg/L during therapy may be warranted to optimize clinical success and minimize toxicity.

Citovat

LUONG, Me-Linh, Mona AL-DABBAGH, Andreas H. GROLL, Zdeněk RÁČIL, Yasuhito NANNYA, Dimitra MITSANI a Shahid HUSAIN. Utility of voriconazole therapeutic drug monitoring: a meta-analysis. Journal of Antimicrobial Chemotherapy. Oxford: Oxford University Press, 2016, roč. 71, č. 7, s. 1786-1799. ISSN 0305-7453. Dostupné z: https://dx.doi.org/10.1093/jac/dkw099.

@article{1345387,
   author = {Luong, MeandLinh and AlandDabbagh, Mona and Groll, Andreas H. and Ráčil, Zdeněk and Nannya, Yasuhito and Mitsani, Dimitra and Husain, Shahid},
   article_location = {Oxford},
   article_number = {7},
   doi = {http://dx.doi.org/10.1093/jac/dkw099},
   keywords = {INVASIVE FUNGAL-INFECTIONS; ADVERSE EVENTS; PLASMA-CONCENTRATIONS; BLOOD-CONCENTRATION; CLINICAL-OUTCOMES; EFFICACY; ASPERGILLOSIS; MULTICENTER; GUIDELINES; DISEASES},
   language = {eng},
   issn = {0305-7453},
   journal = {Journal of Antimicrobial Chemotherapy},
   title = {Utility of voriconazole therapeutic drug monitoring: a meta-analysis},
   volume = {71},
   year = {2016}
}

TY  - JOUR
ID  - 1345387
AU  - Luong, Me-Linh - Al-Dabbagh, Mona - Groll, Andreas H. - Ráčil, Zdeněk - Nannya, Yasuhito - Mitsani, Dimitra - Husain, Shahid
PY  - 2016
TI  - Utility of voriconazole therapeutic drug monitoring: a meta-analysis
JF  - Journal of Antimicrobial Chemotherapy
VL  - 71
IS  - 7
SP  - 1786-1799
EP  - 1786-1799
PB  - Oxford University Press
SN  - 03057453
KW  - INVASIVE FUNGAL-INFECTIONS
KW  - ADVERSE EVENTS
KW  - PLASMA-CONCENTRATIONS
KW  - BLOOD-CONCENTRATION
KW  - CLINICAL-OUTCOMES
KW  - EFFICACY
KW  - ASPERGILLOSIS
KW  - MULTICENTER
KW  - GUIDELINES
KW  - DISEASES
N2  - Background: Voriconazole therapeutic drug monitoring (TDM) is increasingly used in clinical practice. However, the utility of voriconazole TDM to guide therapy remains uncertain and controversial. We conducted a metaanalysis of studies assessing the relationship between voriconazole serum concentration and clinical outcomes of success and toxicity. Methods: We searched bibliographic databases for studies on voriconazole serum concentrations and clinical outcomes. We compared success outcomes between patients with therapeutic and subtherapeutic voriconazole serum concentrations, and toxicity outcomes between patients with and without supratherapeutic serum concentrations. Results: Twenty-four studies were analysed. Pooled analysis for efficacy endpoint demonstrated that patients with therapeutic voriconazole serum concentrations (1.0–2.2 mg/L) were more likely to have successful outcomes compared with those with subtherapeutic voriconazole serum concentrations (OR 2.30; 95% CI 1.39–3.81). A therapeutic threshold of 1.0 mg/L was most predictive of successful outcome (OR 1.94; 95% CI 1.04–3.62). Patients with therapeutic concentrations did not have better survival rates. Pooled analysis for toxicity endpoint demonstrated that patients with supratherapeutic voriconazole serum concentrations (4.0–6.0 mg/L) were at increased risk of toxicity (OR 4.17; 95% CI 2.08–8.36). A supratherapeutic threshold of 6.0 mg/L was most predictive of toxicity (OR 4.60; 95% CI 1.49–14.16). Conclusions: Patients with therapeutic voriconazole serum concentrations were twice as likely to achieve successful outcomes. The likelihood of toxicity associated with supratherapeutic voriconazole serum concentrations was 4-fold that of therapeutic concentrations. Our findings suggest that the use of voriconazole TDM to aim for serum concentrations between 1.0 and 6.0 mg/L during therapy may be warranted to optimize clinical success and minimize toxicity.
ER  -

LUONG, Me-Linh, Mona AL-DABBAGH, Andreas H. GROLL, Zdeněk RÁČIL, Yasuhito NANNYA, Dimitra MITSANI a Shahid HUSAIN. Utility of voriconazole therapeutic drug monitoring: a meta-analysis. \textit{Journal of Antimicrobial Chemotherapy}. Oxford: Oxford University Press, 2016, roč.~71, č.~7, s.~1786-1799. ISSN~0305-7453. Dostupné z: https://dx.doi.org/10.1093/jac/dkw099.

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