• Media type: E-Article
  • Title: Clinical considerations on posaconazole administration and therapeutic drug monitoring in allogeneic hematopoietic cell transplant recipients
  • Contributor: Kraljevic, Mateja; Khanna, Nina; Medinger, Michael; Passweg, Jakob; Masouridi-Levrat, Stavroula; Chalandon, Yves; Mueller, Nicolas J; Schanz, Urs; Vernaz, Nathalie; Van Delden, Christian; Neofytos, Dionysios; Patrizia, Amico; Andres, Axel; John-David, Aubert; Vanessa, Banz; Beckmann, Sonja; Guido, Beldi; Christian, Benden; Christoph, Berger; Isabelle, Binet; Pierre-Yves, Bochud; Sanda, Branca; Heiner, Bucher; Thierry, Carrel; [...]
  • imprint: Oxford University Press (OUP), 2021
  • Published in: Medical Mycology
  • Language: English
  • DOI: 10.1093/mmy/myaa106
  • ISSN: 1369-3786; 1460-2709
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:p>There is a paucity of data on posaconazole (PCZ) dosing and therapeutic-drug-monitoring (TDM) in allogeneic hematopoietic cell transplant recipients (allogeneic-HCTr). This was a 3-year retrospective multicenter study (January 1, 2016 to December 31, 2018) in adult allogeneic-HCTr who received PCZ (intravenously, IV and/or as delayed-release tablet, DRT) as prophylaxis or treatment for ≥7 consecutive days (D) with at least 1-PCZ-level available using data of the Swiss Transplant Cohort Study. The primary objective was to describe the distribution of PCZ-level and identify predictors of therapeutic PCZ-level and associations between PCZ-dosing and PCZ-level. A total of 288 patients were included: 194 (67.4%) and 94 (32.6%) received PCZ as prophylaxis and treatment, respectively, for a median of 90 days (interquartile range, IQR: 42–188.5). There were 1944 PCZ-level measurements performed, with a median PCZ level of 1.3 mg/L (IQR: 0.8-1.96). PCZ-level was &amp;lt;0.7 mg/L in 383/1944 (19.7%) and &amp;lt;1.0 mg/L in 656/1944 (33.7%) samples. PCZ-level was &amp;lt;0.7 mg/L in 260/1317 (19.7%) and &amp;lt;1.0 mg/L in 197/627 (31.4%) in patients who received PCZ-prophylaxis versus treatment, respectively. There were no significant differences in liver function tests between baseline and end-of-treatment. There were nine (3.1%) breakthrough invasive fungal infections (bIFI), with no difference in PCZ levels between patients with or without bIFI. Despite a very intensive PCZ-TDM, PCZ-levels remain below target levels in up to one-third of allogeneic-HCTr. Considering the low incidence of bIFI observed among patients with PCZ levels in the targeted range, our data challenge the clinical utility of routine universal PCZ-TDM.</jats:p>
  • Access State: Open Access