Importance of voriconazole therapeutic drug monitoring in pediatric cancer patients with invasive aspergillosis1. Issue 1 (8th August 2012)

• Record Type: Journal Article
• Authors: Choi, Soo‐Han; Lee, Soo‐Youn; Hwang, Ji‐Young; Lee, Soo Hyun; Yoo, Keon Hee; Sung, Ki Woong; Koo, Hong Hoe; Kim, Yae‐Jean
• Is Part Of: Pediatric blood & cancer. Volume 60:Issue 1(2013:Jan.)
• Page Start: 82
• Page End: 87
• Publication Date: 2012-08-08
• Subjects: Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.24262
• Languages: English
• ISSNs: 1545-5009

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Background</title> <p>Voriconazole is the drug of choice for invasive aspergillosis (IA) and drug levels are influenced by interactions with other drugs and genetic predisposition. We performed a retrospective analysis of voriconazole drug levels and investigated the adequacy of drug levels in pediatric cancer patients and hematopoietic cell transplant (HCT) recipients with IA.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Procedure</title> <p>Trough serum concentrations of voriconazole in patients younger than 19 years during a 30‐month period were analyzed. The therapeutic range was determined as 1–6 µg/ml.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Results</title> <p>A total of 193 voriconazole measurements at steady‐state [86 on intravenous (IV) and 107 on oral (PO) doses] were obtained from 27 patients (median age 12.2 years). On the first monitoring, 19 patients (70.4%) achieved the therapeutic range. However, only 10 patients (37.0%) achieved the therapeutic range on second monitoring. Sixty‐four percent of the total measurements were within the therapeutic range: 66.3% of IV and 61.7% of PO. A significant correlation between oral doses and trough levels of voriconazole was observed in patients ≤6 years old (Spearman's rank correlation coefficient = 0.4819, <italic>P</italic> = 0.027). Patients aged ≤6 years needed a significantly higher median dose of PO voriconazole to maintain therapeutic trough levels compared to older patient groups (8.9 vs. 4.2 mg/kg/dose, <italic>P</italic> < 0.001). Voriconazole level <1 µg/ml was more frequently observed in patients with treatment failure at week 6 of voriconazole therapy (failure vs. success, 42.1% vs. 19.7%; <italic>P</italic> = 0.012).</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Conclusions</title> <p>Serum concentrations of voriconazole in children were variable, depending on the patient's age and route of administration. Continuous and careful drug level monitoring should be performed. Pediatr Blood Cancer 2013; 60: 82–87. © 2012 Wiley Periodicals, Inc.</p> </sec> </abstract>