Treatment of Chronic Pulmonary Aspergillosis by Voriconazole in Nonimmunocompromised Patients

Camuset, Juliette; Nunès, Hilario; Dombret, Marie-Christine; Bergeron, Anne; Henno, Priscilla; Philippe, B.; Dauriat, Gaëlle; Mangiapan, G.; Rabbat, Antoine; Cadranel, Jacques

doi:10.1378/chest.06-2441

Cited by 156 publications

(162 citation statements)

References 30 publications

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“…[4][5][6] Of the long-term sequelae of PTB, CPA is perhaps the most subtle, yet the most severe. [4][5][6][7][8][9][10][11] In the 1960s the Research Committee of the British Thoracic and Tuberculosis Association estimated the prevalence of CPA in patients who had a residual cavity of at least 2.5 cm on the chest radiograph following treatment for PTB. 9,12 It assessed more than 500 patients from 55 chest clinics twice -once about 12 months after the sputum became negative for acid fast bacilli, 12 and again three years later.…”

Section: Introductionmentioning

confidence: 99%

“…Morbidity is considerable and is marked by both systemic and respiratory symptoms and haemoptysis. 7,8 Weight loss, profound fatigue, severe shortness of breath and life-threatening haemoptysis are common. Progressive pulmonary fibrosis and loss of lung function, also common, could partly account for the unexplained loss of lung function in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis

Denning¹,

Pleuvry²,

Cole³

2011

Bull World Health Org

341

366

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis

Denning¹,

Pleuvry²,

Cole³

2011

Bull World Health Org

341

366

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“…The common characteristics of these forms, however, consist of 1) underlying pulmonary disorders, 2) the status of low-grade immunosuppression, and 3) less than severe findings of angioinvasion in histopathology. 1,5,7 Numerous clinical cases and few retrospective studies have been reported for the treatment of CPA [8][9][10][11][12] ; however, there are no large-scale clinical trials have been conducted.…”

Section: Introductionmentioning

confidence: 99%

Intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis: A multicenter trial in Japan

Kohno

Izumikawa

Ogawa

et al. 2010

Journal of Infection

105

129

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SUMMARYChronic pulmonary aspergillosis (CPA) is slowly progressive inflammatory pulmonary syndrome due to Aspergillus spp. The evidence regarding CPA treatment is limited. We conducted a randomized, multicenter, open-label trial comparing intravenous micafungin (MCFG) of 150-300 mg once daily with intravenous voriconazole (VRCZ) of 6 mg/kg twice on Day 1 followed by 4 mg/kg twice daily for the treatment of 107 inpatients with CPA to compare the efficacy and safety of both drugs as initial treatment in Japan.

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“…41,42 The only literature to date that has investigated the role of voriconazole for treatment of invasive aspergillosis in patients without immunocompromise was a retrospective trial involving patients with chronic necrotizing pulmonary aspergillosis. 43 In that study, 58% of the patients had a response to voriconazole by the end of follow-up, after a median duration of treatment of 9 months.…”

Section: Aspergillosismentioning

confidence: 87%

Role of Therapeutic Drug Monitoring of Voriconazole in the Treatment of Invasive Fungal Infections

Kuo

Ensom

2009

CJHP

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Background: Voriconazole is a broad-spectrum, second-generation triazole antifungal agent with demonstrated efficacy in the treatment of invasive fungal infections caused by Aspergillus spp. and Candida spp. Given the characteristically poor prognosis of patients with invasive fungal infections and the protracted duration of treatment required, therapeutic monitoring of voriconazole is, in theory, an attractive method to optimize antifungal therapy. Objective:To determine the utility of therapeutic drug monitoring for voriconazole. Methods:A previously published decision-making algorithm was used to assess the currently available literature on therapeutic drug monitoring of voriconazole.Results: Several analytical methods can be used to quantify plasma or serum concentrations of voriconazole. Reasons for therapeutic monitoring of this drug include wide variability both within and between individuals secondary to drug properties, drug-drug interactions, and disease states. Furthermore, voriconazole follows nonlinear pharmacokinetics with saturable hepatic clearance. Another potential factor in favour of therapeutic drug monitoring for voriconazole is genetic polymorphism of CYP2C19, whereby patients who are homozygous for poor metabolism (about 19% of non-Indian Asians) can have 4-fold greater exposure to voriconazole. The concentrations of this drug are also greater in patients with hepatic impairment. Drug-drug interactions with other substrates of CYP2C9, CYP2C19, and CYP3A4 can also alter voriconazole concentrations. However, the correlations between plasma concentrations of voriconazole and its efficacy and toxicity are not well defined. Although lower and upper target thresholds of 0.25-2 mg/L and 4-6 mg/L, respectively, have been suggested, studies to date have not been appropriately designed or powered to reveal any definitive association. Conclusions:Routine therapeutic drug monitoring of voriconazole is not recommended except in certain circumstances, such as lack of response to therapy or evidence of toxicity, in which case selective monitoring of voriconazole concentrations may be of clinical utility. Méthodes : Un algorithme de prise de décision publié a été utilisé pour évaluer la documentation actuellement disponible sur le suivi thérapeutique pharmacologique du voriconazole. Résultats :Plusieurs méthodes analytiques peuvent servir à quantifier les concentrations sériques ou plasmatiques de voriconazole. Les raisons de recourir au suivi thérapeutique pharmacologique de ce médicament sont notamment la grande variabilité intra et interindividuelle attribuable aux propriétés du médicament, aux interactions médicament-médicament et aux affections. De plus, le voriconazole a un comportement pharmacocinétique non linéaire en raison d'une clairance hépatique saturable. Un autre facteur potentiellement en faveur du suivi thérapeutique pharmacologique du voriconazole est le polymorphisme génétique du CYP2C19 qui, chez les patients homozygotes ayant un faible métabolisme (environ 19 % des Asiatiques ...

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Treatment of Chronic Pulmonary Aspergillosis by Voriconazole in Nonimmunocompromised Patients

Cited by 156 publications

References 30 publications

Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis

Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis

Intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis: A multicenter trial in Japan

Role of Therapeutic Drug Monitoring of Voriconazole in the Treatment of Invasive Fungal Infections

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