Importance of voriconazole therapeutic drug monitoring in pediatric cancer patients with invasive aspergillosis.

Pediatr Blood Cancer. 2012 Aug 8. doi: 10.1002/pbc.24262. [Epub ahead of print]

Importance of voriconazole therapeutic drug monitoring in pediatric cancer patients with invasiveaspergillosis.

Source

Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.

Abstract

BACKGROUND:

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.

PROCEDURE:

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.

RESULTS:

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, P = 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, P < 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%; P = 0.012).

CONCLUSIONS:

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 © 2012 Wiley Periodicals, Inc.

Copyright © 2012 Wiley Periodicals, Inc.

PMID:

 22887791

[PubMed – as supplied by publisher]

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