Clinical Practice Guideline for the Therapeutic Drug Monitoring of Voriconazole in Non-Asian and Asian Adult Patients: Consensus Review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring

医学 指南 加药 槽水位 不利影响 治疗药物监测 药品 伏立康唑 槽浓度 重症监护医学 优势比 荟萃分析 药理学 内科学 药代动力学 抗真菌 病理 皮肤病科 他克莫司 移植
作者
Yoshio Takesue,Yuki Hanai,Kazutaka Oda,Yukihiro Hamada,Takashi Ueda,Toshihiko Mayumi,Kazuaki Matsumoto,Satoshi Fujii,Yoshiko Takahashi,Yoshitsugu Miyazaki,Toshimi Kimura
出处
期刊:Clinical Therapeutics [Elsevier BV]
卷期号:44 (12): 1604-1623 被引量:38
标识
DOI:10.1016/j.clinthera.2022.10.005
摘要

Voriconazole, an antifungal drug, is metabolized by a cytochrome P450 isozyme. Increased adverse effects are observed in Asians because of the high rate of poor metabolizers. In this therapeutic drug monitoring (TDM) guideline, recommendations were made according to ethnic group.Five clinical questions were used. For the preparation of the guideline, the performance of TDM in multicenter studies was surveyed (study 1). We also conducted a systematic review and meta-analysis (study 2) to establish recommendations for non-Asians and Asians.In study 1, 401 patients were surveyed. A risk of supratherapeutic concentrations was found in Japanese patients who adhered to the recommended dose. Target trough levels were achieved in 87% of patients with dose reductions. Although the trough level measured at the onset of adverse effects (AEs) was significantly associated with hepatotoxicity, no significant correlation was found between the initial trough level and hepatotoxicity, which indicated that hepatotoxicity was successfully prevented by the trough-guided dosing. In study 2, 22 studies (11 Asian locations and 11 non-Asian locations) were included in meta-analysis for the relationship between trough cutoff level (3, 4, 5, 5.5, and 6 µg/mL) and AEs. Significant differences were found for all cutoff levels, with the highest odds ratio for 4.0 µg/mL in Asian locations. In contrast, in non-Asian locations, no more than 1 study was available for any trough cutoff level, except for 5.5 µg/mL, at which level a significant increase in AEs was found. These findings indicate that TDM is strongly recommended to prevent AEs in Asians, and TDM is generally recommended for non-Asians to address subtherapeutic concentrations. TDM on day 3 is recommended to assess pharmacokinetic properties, including loading and maintenance doses. If the patient condition permits, delaying until day 5 is suggested for Asians because of the prolonged t½ in poor metabolizers. A trough level ≥1.0 µg/mL is strongly recommended to improve efficacy. Trough levels ≥2.0 µg/mL are suggested for invasive aspergillosis. To decrease adverse effects, trough levels <4.0 µg/mL are strongly recommended in Asians, whereas trough levels <5.5 µg/mL are generally recommended in non-Asians. Maintenance doses of 4 and 3 mg/kg twice daily are recommended in non-Asians and Asians, respectively.Different indications, timings, and target trough levels for TDM and different regimens are suggested for Asians and non-Asians.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
刚刚
xiaofeiyan发布了新的文献求助20
1秒前
星空_完成签到 ,获得积分10
1秒前
風起天岚完成签到,获得积分10
2秒前
赘婿应助震动的化蛹采纳,获得10
2秒前
云村的乌拉完成签到,获得积分10
2秒前
5秒前
单向度的人完成签到,获得积分20
6秒前
huang1499完成签到,获得积分10
6秒前
7秒前
huang1499发布了新的文献求助10
8秒前
9秒前
10秒前
yoyocici1505完成签到,获得积分10
10秒前
帅气的Bond发布了新的文献求助10
11秒前
YHK完成签到,获得积分10
13秒前
松松老师关注了科研通微信公众号
13秒前
爆米花应助魔幻问薇采纳,获得10
16秒前
GQL发布了新的文献求助10
16秒前
17秒前
无敌葡萄爱学习完成签到,获得积分10
17秒前
帅气的Bond完成签到,获得积分10
18秒前
爆米花应助曼凡采纳,获得10
18秒前
坚定的凝云完成签到 ,获得积分10
19秒前
壮观鞋垫发布了新的文献求助10
20秒前
新新新完成签到,获得积分10
20秒前
21秒前
六五发布了新的文献求助10
21秒前
英姑应助GQL采纳,获得10
22秒前
且听风吟完成签到,获得积分10
23秒前
deng完成签到 ,获得积分10
23秒前
23秒前
24秒前
25秒前
畅快菠萝完成签到,获得积分10
25秒前
Uki完成签到 ,获得积分10
25秒前
26秒前
28秒前
2025发布了新的文献求助10
28秒前
量子星尘发布了新的文献求助10
29秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Picture Books with Same-sex Parented Families: Unintentional Censorship 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
A Preliminary Study on Correlation Between Independent Components of Facial Thermal Images and Subjective Assessment of Chronic Stress 500
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3971516
求助须知:如何正确求助?哪些是违规求助? 3516229
关于积分的说明 11181488
捐赠科研通 3251405
什么是DOI,文献DOI怎么找? 1795821
邀请新用户注册赠送积分活动 876051
科研通“疑难数据库(出版商)”最低求助积分说明 805245