Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy and haemopoietic stem cell transplant recipients, 2021. (22nd December 2021)

• Record Type: Journal Article
• Authors: Chau, Maggie M.; Daveson, Kathryn; Alffenaar, Jan‐Willem C.; Gwee, Amanda; Ho, Su Ann; Marriott, Deborah J. E.; Trubiano, Jason A.; Zhao, Jessie; Roberts, Jason A.
• Other Names: Slavin Monica A. investigator.; Thursky Karin A. investigator.; Roberts Jason A. investigator.; Worth Leon J. investigator.; Chang Christina C. investigator.; Chen Sharon C‐A investigator.; Morrissey C. Orla investigator.; Blyth Christopher C. investigator.; Khanina Anna investigator.
• Is Part Of: Internal medicine journal. Volume 51(2021)Supplement 7
• Page Start: 37
• Page End: 66
• Publication Date: 2021-12-22
• Subjects: antifungal therapy -- toxicity -- drug interaction -- therapeutic drug monitoring -- pharmacogenomics; Medicine -- Periodicals; 616
• DOI: 10.1111/imj.15587
• Languages: English
• ISSNs: 1444-0903

Abstract

Abstract: Antifungal agents can have complex dosing and the potential for drug interaction, both of which can lead to subtherapeutic antifungal drug concentrations and poorer clinical outcomes for patients with haematological malignancy and haemopoietic stem cell transplant recipients. Antifungal agents can also be associated with significant toxicities when drug concentrations are too high. Suboptimal dosing can be minimised by clinical assessment, laboratory monitoring, avoidance of interacting drugs, and dose modification. Therapeutic drug monitoring (TDM) plays an increasingly important role in antifungal therapy, particularly for antifungal agents that have an established exposure‐response relationship with either a narrow therapeutic window, large dose‐exposure variability, cytochrome P450 gene polymorphism affecting drug metabolism, the presence of antifungal drug interactions or unexpected toxicity, and/or concerns for non‐compliance or inadequate absorption of oral antifungals. These guidelines provide recommendations on antifungal drug monitoring and TDM‐guided dosing adjustment for selected antifungal agents, and include suggested resources for identifying and analysing antifungal drug interactions. Recommended competencies for optimal interpretation of antifungal TDM and dose recommendations are also provided.