Utility of voriconazole therapeutic drug monitoring: a meta-analysis

LUONG, Me-Linh, Mona AL-DABBAGH, Andreas H. GROLL, Zdeněk RÁČIL, Yasuhito NANNYA, Dimitra MITSANI and Shahid HUSAIN. Utility of voriconazole therapeutic drug monitoring: a meta-analysis. Journal of Antimicrobial Chemotherapy. Oxford: Oxford University Press, 2016, vol. 71, No 7, p. 1786-1799. ISSN 0305-7453. Available from: https://dx.doi.org/10.1093/jac/dkw099.

Basic information

Original name

Utility of voriconazole therapeutic drug monitoring: a meta-analysis

Authors

LUONG, Me-Linh (124 Canada), Mona AL-DABBAGH (124 Canada), Andreas H. GROLL (276 Germany), Zdeněk RÁČIL (203 Czech Republic, guarantor, belonging to the institution), Yasuhito NANNYA (392 Japan), Dimitra MITSANI (840 United States of America) and Shahid HUSAIN (124 Canada)

Edition

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

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Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30104 Pharmacology and pharmacy

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 5.071

RIV identification code

RIV/00216224:14110/16:00089949

Organization unit

Faculty of Medicine

DOI

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

UT WoS

000383246000005

Keywords in English

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

Tags

EL OK

Tags

International impact, Reviewed

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Abstract

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.