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. |
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@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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