Voriconazole Treatment for Subacute Invasive and Chronic Pulmonary Aspergillosis

Sambatakou, Helen; Dupont, B.; Lode, H.; Denning, David W.

doi:10.1016/j.amjmed.2005.11.028

Cited by 100 publications

(95 citation statements)

References 27 publications

(45 reference statements)

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“…39 A similar trial performed later involved 36 patients with subacute invasive and chronic pulmonary aspergillosis who were receiving voriconazole as primary or salvage therapy. 40 The rates of therapeutic response and toxic effects were comparable to those observed by Denning and others. 24 Smaller observational studies and case reports have also demonstrated the efficacy of voriconazole for treatment of invasive aspergillosis in specific populations of immunocompromised patients.…”

Section: Aspergillosissupporting

confidence: 72%

“…For invasive pulmonary aspergillosis, the recommended treatment duration is a minimum of 6 to 12 weeks, whereas chronic pulmonary aspergillosis may require treatment with voriconazole for several months. 16,40 Rarely would a patient be receiving voriconazole for less than 2 weeks, especially given that empiric therapy with voriconazole in febrile neutropenia is not recommended. In summary, if TDM is indicated (as determined by earlier steps in the algorithm shown in Figure 1), the duration of voriconazole therapy is adequate and appropriate to allow TDM to be performed and patient therapy to benefit.…”

Section: Duration Of Therapymentioning

confidence: 99%

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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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Section: Aspergillosissupporting

confidence: 72%

Section: Duration Of Therapymentioning

confidence: 99%

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

Kuo

Ensom

2009

CJHP

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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

106

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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“…(1,2). However, in previous reports, the majority of patients with CNPA have been diagnosed according to clinical criteria (3)(4)(5)(6). We conducted a histopathological study of lung specimens obtained by autopsy, surgical resection, or biopsy to clarify the characteristic pathological and clinical features of CNPA, which was diagnosed in a total of 4 patients.…”

mentioning

confidence: 99%

A Case Series of Chronic Necrotizing Pulmonary Aspergillosis and a New Proposal

et al. 2013

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SUMMARY: Chronic necrotizing pulmonary aspergillosis (CNPA) is an indolent, cavitating process in the lungs resulting from invasion of lung tissue by Aspergillus spp. However, most previous reports have not found any clear evidence of parenchymal invasion, and clinical distinction between CNPA and chronic cavitary pulmonary aspergillosis (CCPA) is difficult. We performed a histopathological study of lung specimens obtained by autopsy, surgical resection, or biopsy to clarify the characteristic pathological and clinical features of CNPA. We present 4 cases of proven CNPA, diagnosed by histological demonstration of tissue invasion by the fungus, and present its clinical features. These 4 patients were male, and the mean age was 62 years (range, 51-75 years). Their underlying conditions were chronic obstructive pulmonary disease (n ＝ 3), sequelae of pulmonary tuberculosis (n ＝ 2), and diabetes mellitus (n ＝ 1). Aspergillus precipitation tests were positive for 3; and Aspergillus antigen tests were positive for 2 on admission, and subsequently, for all 4. The isolated pathogens were Aspergillus niger for 1 and A. fumigatus for 1. Initial radiographic findings were infiltrates or nodular lesions, which slowly progressed and cavitated before the appearance of fungus balls. Although CNPA has characteristic pathological features, it is clinically difficult to distinguish CNPA from CCPA. We propose to use the term chronic progressive pulmonary aspergillosis for both CNPA and CCPA.

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Voriconazole Treatment for Subacute Invasive and Chronic Pulmonary Aspergillosis

Abstract: In patients with subacute IA and CPA, voriconazole was efficacious as salvage or primary therapy.

Cited by 100 publications

References 27 publications

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

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

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

A Case Series of Chronic Necrotizing Pulmonary Aspergillosis and a New Proposal

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