Voriconazole treatment in adults and children with hematological diseases: can it be used without measurement of plasma concentration?

Corrado Girmenia, Luciana Annino, Alice Bertaina, Benedetta Mariotti, Désirée Caselli, Rosa Fanci, Walter Barberi, Francesco Marchesi, Alessandra Carotti, Antonella Ferrari, Elisabetta Cerchiara, Luca Cupelli, Francesco Arcioni, Michela Ribersani, Anna Proia, Claudio Cartoni, Katia Girardi, Adriano Venditti, Maria Iris Cassetta, Stefania FallaniAndrea Novelli

Research output: Contribution to journalArticlepeer-review

Abstract

Indication and timing of trough plasma-voriconazole (VCZ)-concentration (t-PVC) measurement during VCZ treatment is a debated issue. Patterns of t-PVC were prospectively evaluated in pediatric (50 courses) and adult (95 courses) hematologic patients. Efficacy patterns were defined: adequate, t-PVC always ≥1 mcg/ml; borderline, at least one t-PVC measurement <1 mcg/ml but median value of the measurements ≥1 mcg/ml; inadequate, median value of the measurements <1 mcg/ml. Toxicity patterns were defined: favorable, t-PVC always ≤5 mcg/ml; borderline, one or more t-PVC measurements >5 mcg/ml but median value of the measurements ≤5 mcg/ml; unfavorable, median value of the measurements >5 mcg/ml. In children and adults the mean t-PVCs were higher during intravenous treatments. The t-PVC efficacy pattern was adequate, borderline and inadequate in 48%, 12%, and 40% of courses, respectively, in children, and in 66.3%, 16.8%, and 16.8% of courses, respectively, in adults. Adequate efficacy pattern was more frequent in children with body weight above the median (≥25 kg) (OR 4.8; P = .011) and in adults with active hematological disease receiving intravenous therapy (OR 3.93; P = .006). Favorable toxicity pattern was more frequent in children receiving VCZ daily dosage below the median (<14 mg/kg) (OR 4.18; P = .027) and in adults with body weight below the median (<68 kg) (OR 0.22; P = .004). T-PVC measurement is generally needed, however, a non t-PVC guided approach may be considered in heavier adults receiving intravenous VCZ. The risk of supratherapeutic levels does not seem an absolute indication for t-PVC monitoring.

Original languageEnglish
Pages (from-to)263-278
JournalMedical Mycology
Volume56
Issue number3
DOIs
Publication statusPublished - 2018

Keywords

  • Journal Article

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