Journal
THERAPEUTIC DRUG MONITORING
Volume 44, Issue 5, Pages 641-650Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/FTD.0000000000000980
Keywords
oncohematologic pediatric patients; isavuconazole; voriconazole; clinical pharmacological advice; dosage adjustments
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This study found that in hemato-oncological pediatric patients, there was a low need for dose adjustments when using isavuconazole as antifungal prophylaxis, while a high need for dose adjustments when using voriconazole. Isavuconazole showed relatively stable blood concentrations, while voriconazole exhibited higher variability.
Background: Limited evidence concerning optimal azole dosing regimens currently exists for antifungal prophylaxis in hemato-oncological pediatric patients. Methods: Hemato-oncological children receiving intravenous or oral isavuconazole or voriconazole for primary antifungal prophylaxis at IRCCS Azienda Ospedaliero-Universitaria of Bologna during November 2020 to October 2021 and undergoing CPA programs based on real-time therapeutic drug monitoring (TDM) were retrospectively analyzed. CPAs for isavuconazole and voriconazole and the number of dosage adjustments were collected. Normalized trough concentrations [(C-min)/dose/kg] were calculated for both drugs at each TDM assessment, and the coefficient of variation was determined. The efficacy and safety of the drugs were evaluated. Results: Sixteen hemato-oncological pediatric patients received azole prophylaxis (mean age and weight: 9.1 +/- 4.9 years and 32.6 +/- 16.0 kg; 6 isavuconazole and 10 voriconazole). Sixty and 89 CPAs were delivered as isavuconazole and voriconazole, respectively. Dosage adjustments were needed in 3.3% of cases for isavuconazole and 53.9% of cases for voriconazole (P < 0.001). At first TDM, achievement of the desired target during standard dosing regimens was higher for isavuconazole (83.3%) than for voriconazole (10.0%; P = 0.008). Dispersion of normalized concentrations was higher for voriconazole (CV = 139.1% vs. CV = 79.4%). Elevation of ALT and aspartate aminotransferase levels between baseline and the third month was higher in patients receiving voriconazole (median, 28 vs. 90 U/L; P = 0.038, and 19 vs. 65.5 U/L; P = 0.002). Conclusions: Our findings suggest that there is limited variability in isavuconazole exposure in hemato-oncological pediatric patients receiving azole prophylaxis, resulting in a low need for CPA-guided dosage adjustments.
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