Detailed Information on Publication Record
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.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
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
UT WoS
000383246000005
Keywords in English
INVASIVE FUNGAL-INFECTIONS; ADVERSE EVENTS; PLASMA-CONCENTRATIONS; BLOOD-CONCENTRATION; CLINICAL-OUTCOMES; EFFICACY; ASPERGILLOSIS; MULTICENTER; GUIDELINES; DISEASES
Tags
Tags
International impact, Reviewed
Změněno: 25/10/2016 10:45, Ing. Mgr. Věra Pospíšilíková
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.