| Title |
Voriconazole therapeutic drug monitoring: retrospective cohort study of the relationship to clinical outcomes and adverse events
|
|---|---|
| Published in |
BMC Infectious Diseases, February 2013
|
| DOI | 10.1186/1471-2334-13-105 |
| Pubmed ID | |
| Authors |
Helen Y Chu, Rupali Jain, Hu Xie, Paul Pottinger, David N Fredricks |
| Abstract |
ABSTRACT: BACKGROUND: Voriconazole is approved for treatment of invasive aspergillosis and other invasive fungal infections, but the role for therapeutic drug monitoring (TDM) is not clear. METHODS: We performed a retrospective cohort study of patients at the University of Washington Medical Center and Fred Hutchinson Cancer Research Center from 2007--2009. We compared the effect of therapeutic levels on clinical outcomes and evaluated the relationship between drug levels and adverse events. RESULTS: A total of 108 patients had voriconazole TDM performed, of whom 84 (77.8%) had a hematologic malignancy and 47 (43.5%) had undergone hematopoietic stem cell transplantation. The primary reasons for treatment were presumed pulmonary aspergillosis (n = 83, 76.8%), other invasive mould infections (n = 13, 12.0%) and candidiasis (n = 9, 8.3%). There was a high degree of variability in voriconazole drug levels among patients (r2 = 0.01; range, <0.10 - 20 mg/L). Of the 46 patients with proven or probable invasive fungal disease, 25 (54.3%) achieved partial or complete response to therapy. There was no significant relationship between therapeutic drug levels and achievement of complete or partial response at 12 weeks (OR 0.29, 95% CI: 0.05-1.34) or radiologic response (OR 1.46, 95% CI: 0.32-7.83). Overall, 45 (41.7%) patients experienced adverse events. Voriconazole levels > 5.5 mg/L were not associated with increased incidence of encephalopathy (OR 3.08, 95% CI 0.79-11.0) or hepatotoxicity (OR 2.45, 95% CI 0.49-10.1). CONCLUSIONS: Voriconazole therapeutic drug levels were not associated with improvement in clinical outcomes among patients with proven or probable invasive fungal disease. We also did not find an association between supratherapeutic drug levels and hepatoxicity or encephalopathy. It is possible that the utility of voriconazole therapeutic drug monitoring to improve clinical efficacy or decrease adverse events may be limited to a subset of high-risk patients. |
X Demographics
The data shown below were collected from the profiles of 3 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Canada | 1 | 33% |
| Unknown | 2 | 67% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 2 | 67% |
| Scientists | 1 | 33% |
Mendeley readers
The data shown below were compiled from readership statistics for 56 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 1 | 2% |
| Unknown | 55 | 98% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 10 | 18% |
| Other | 8 | 14% |
| Student > Bachelor | 5 | 9% |
| Student > Ph. D. Student | 4 | 7% |
| Student > Postgraduate | 4 | 7% |
| Other | 16 | 29% |
| Unknown | 9 | 16% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 25 | 45% |
| Pharmacology, Toxicology and Pharmaceutical Science | 6 | 11% |
| Biochemistry, Genetics and Molecular Biology | 4 | 7% |
| Agricultural and Biological Sciences | 3 | 5% |
| Nursing and Health Professions | 2 | 4% |
| Other | 5 | 9% |
| Unknown | 11 | 20% |
Attention Score in Context
This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 02 March 2013.
All research outputs
#14,746,859
of 22,699,621 outputs
Outputs from BMC Infectious Diseases
#4,048
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Outputs of similar age
#116,502
of 192,953 outputs
Outputs of similar age from BMC Infectious Diseases
#92
of 163 outputs
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