51
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Chouchane I, Stremler‐Lebel N, Reix P. Lumacaftor/ivacaftor initiation in two liver transplantation patients under tacrolimus and antifungal azoles. Clin Case Rep 2019; 7:616-618. [PMID: 30997048 PMCID: PMC6452481 DOI: 10.1002/ccr3.2053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/11/2019] [Accepted: 01/26/2019] [Indexed: 12/21/2022] Open
Abstract
We report the initiation of CFTR modulator lumacaftor/ivacaftor combination (LUM/IVA) in two adolescents with cystic fibrosis who were treated with antifungal azoles (AZO) and tacrolimus (TCS) for liver transplantation. Despite multiple drug-drug interactions, maintaining therapeutic TCS levels was achievable. During the following year, LUM/IVA was well tolerated, providing clinical benefits.
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Affiliation(s)
- Ikrame Chouchane
- Service de pédiatrie, Hôpital Mère EnfantCentre Hospitalier Universitaire, Hôpital DupuytrenLimogesFrance
| | - Nathalie Stremler‐Lebel
- CRCM pédiatrique MarseilleHôpital Timone‐Enfants, Assistance publique‐Hôpitaux de MarseilleMarseilleFrance
| | - Philippe Reix
- CRCM pédiatrique LyonHôpital Femme Mère Enfant, Hospices Civils de LyonLyonFrance
- UMR 5558 (EMET), CNRS, LBBEUniversité de LyonVilleurbanneFrance
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52
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Han Y, Zhou H, Cai J, Huang J, Zhang J, Shi SJ, Liu YN, Zhang Y. Prediction of tacrolimus dosage in the early period after heart transplantation: a population pharmacokinetic approach. Pharmacogenomics 2019; 20:21-35. [PMID: 30730287 DOI: 10.2217/pgs-2018-0116] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of this study was to evaluate tacrolimus population pharmacokinetics and investigate factors that explain tacrolimus variability in adult heart transplant patients. Methods: A total of 707 tacrolimus concentrations from 107 adult heart transplant patients were included in model development. The effects of demographic, clinical factors and CYP3A5 genotype on tacrolimus clearance were evaluated using a nonlinear mixed-effects modeling. 24 patients with 106 tacrolimus concentrations were used for external validation. Results: The pharmacokinetic data were adequately described by a one-compartment model with first-order absorption and elimination. The estimated apparent clearance and volume of distribution of tacrolimus were 13.7 l/h and 791 l, respectively. Tacrolimus apparent clearance was significantly reduced in CYP3A5 nonexpressers (CYP3A5*3/*3), concomitant with azole antifungal drugs and Wuzhi capsule (WZ). A predictive performance was further confirmed in an external validation by Bayesian estimation. Recommended dose regimens were obtained by simulations based on the established model. Conclusion: This is the first population pharmacokinetic study conducted in Chinese heart transplant recipients. These findings are of great importance with regards to tacrolimus dose optimization in heart transplantation patients.
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Affiliation(s)
- Yong Han
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1277, Jie Fang Road, Wuhan, Hubei province, 430022, PR China
| | - Hong Zhou
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1277, Jie Fang Road, Wuhan, Hubei province, 430022, PR China
| | - Jie Cai
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1277, Jie Fang Road, Wuhan, Hubei province, 430022, PR China
| | - Jun Huang
- Institutes of Antibiotics, Huashan Hospital, Fudan University.12 Middle Urumqi Road, Shanghai, 200040, PR China
| | - Jing Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1277, Jie Fang Road, Wuhan, Hubei province, 430022, PR China
| | - Shao-Jun Shi
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1277, Jie Fang Road, Wuhan, Hubei province, 430022, PR China
| | - Ya-Ni Liu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1277, Jie Fang Road, Wuhan, Hubei province, 430022, PR China
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1277, Jie Fang Road, Wuhan, Hubei province, 430022, PR China
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53
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Kabir V, Maertens J, Kuypers D. Fungal infections in solid organ transplantation: An update on diagnosis and treatment. Transplant Rev (Orlando) 2018; 33:77-86. [PMID: 30579665 DOI: 10.1016/j.trre.2018.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/14/2022]
Abstract
Invasive fungal infections constitute an important cause of morbidity and mortality in solid organ transplantation recipients. Since solid organ transplantation is an effective therapy for many patients with end-stage organ failure, prevention and treatment of fungal infections are of vital importance. Diagnosis and management of these infections, however, remain difficult due to the variety of clinical symptoms in addition to the lack of accurate diagnostic methods. The use of fungal biomarkers can lead to an increased diagnostic accuracy, resulting in improved clinical outcomes. The evidence for optimal prophylactic approaches remains inconclusive, which results in considerable variation in the administration of prophylaxis. The implementation of a standard protocol for prophylaxis remains difficult as previous treatment regimens, which can alter the distribution of different pathogens, affect the outcome of antifungal susceptibility testing. Furthermore, the increasing use of antifungals also contributes to incremental costs and the risk of development of drug resistance. This review will highlight risk factors, clinical manifestations and timing of fungal infections and will focus predominately on the current evidence for diagnosis and management of fungal infections.
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Affiliation(s)
- Vincent Kabir
- KU Leuven, Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Johan Maertens
- KU Leuven, Laboratory of Clinical Bacteriology and Mycology, Herestraat 49, 3000 Leuven, Belgium.
| | - Dirk Kuypers
- KU Leuven, Laboratory of Nephrology, Herestraat 49, 3000 Leuven, Belgium; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Belgium.
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54
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Xie Y, Dilibero D, Chang DH. Review of Major Drug-Drug Interactions in Thoracic Transplantation. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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55
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Vanhove T, Annaert P, Knops N, de Loor H, de Hoon J, Kuypers DRJ. In vivo CYP3A4 activity does not predict the magnitude of interaction between itraconazole and tacrolimus from an extended release formulation. Basic Clin Pharmacol Toxicol 2018; 124:50-55. [DOI: 10.1111/bcpt.13092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Vanhove
- Department of Microbiology and Immunology; KU Leuven - University of Leuven; Leuven Belgium
- Department of Nephrology and Renal Transplantation; University Hospitals Leuven; Leuven Belgium
| | - Pieter Annaert
- Department of Pharmaceutical and Pharmacological Sciences; Drug Delivery and Disposition; KU Leuven- University of Leuven; Leuven Belgium
| | - Noël Knops
- Department of Pediatric Nephrology and Solid Organ Transplantation; University Hospitals Leuven; Leuven Belgium
| | - Henriëtte de Loor
- Department of Microbiology and Immunology; KU Leuven - University of Leuven; Leuven Belgium
- Department of Nephrology and Renal Transplantation; University Hospitals Leuven; Leuven Belgium
| | - Jan de Hoon
- Department of Pharmaceutical and Pharmacological Sciences; Clinical Pharmacology and Pharmacotherapy; KU Leuven; Leuven Belgium
- Department of Pharmaceutical and Pharmacological Sciences; Center for Clinical Pharmacology; University Hospitals Leuven; KU Leuven; Leuven Belgium
| | - Dirk R J Kuypers
- Department of Microbiology and Immunology; KU Leuven - University of Leuven; Leuven Belgium
- Department of Nephrology and Renal Transplantation; University Hospitals Leuven; Leuven Belgium
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56
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Calabrese DR, Florez R, Dewey K, Hui C, Torgerson D, Chong T, Faust H, Rajalingam R, Hays SR, Golden JA, Kukreja J, Singer JP, Greenland JR. Genotypes associated with tacrolimus pharmacokinetics impact clinical outcomes in lung transplant recipients. Clin Transplant 2018; 32:e13332. [PMID: 29920787 DOI: 10.1111/ctr.13332] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 12/18/2022]
Abstract
Most lung transplantation immunosuppression regimens include tacrolimus. Single nucleotide polymorphisms (SNPs) in genes important to tacrolimus bioavailability and clearance (ABCB1, CYP3A4, and CYP3A5) are associated with differences in tacrolimus pharmacokinetics. We hypothesized that polymorphisms in these genes would impact immunosuppression-related outcomes. We categorized ABCB1, CYP3A4, and CYP3A5 SNPs for 321 lung allograft recipients. Genotype effects on time to therapeutic tacrolimus level, interactions with antifungal medications, concentration to dose (C0 /D), acute kidney injury, and rejection were assessed using linear models adjusted for subject characteristics and repeat measures. Compared with CYP3A poor metabolizers (PM), time to therapeutic tacrolimus trough was increased by 5.1 ± 1.6 days for CYP3A extensive metabolizers (EM, P < 0.001). In the post-operative period, CYP3A intermediate metabolizers spent 1.2 ± 0.5 days less (P = 0.01) and EM spent 2.1 ± 0.5 days less (P < 0.001) in goal tacrolimus range than CYP3A PM. Azole antifungals interacted with CYP3A genotype in predicting C0 /D (P < 0.001). Increased acute kidney injury rates were observed in subjects with high ABCB1 function (OR 3.0, 95% CI 1.1-8.6, P = 0.01). Lower rates of acute cellular rejection were observed in subjects with low ABCB1 function (OR 0.36, 95% CI 0.07-0.94, P = 0.02). Recipient genotyping may help inform tacrolimus dosing decisions and risk of adverse clinical outcomes.
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Affiliation(s)
- Daniel R Calabrese
- Department of Medicine, University of California, San Francisco, California
| | - Rebecca Florez
- Department of Clinical Pharmacy, University of California, San Francisco, California
| | - Katherine Dewey
- Department of Clinical Pharmacy, University of California, San Francisco, California
| | - Christine Hui
- Department of Clinical Pharmacy, University of California, San Francisco, California
| | - Dara Torgerson
- Department of Medicine, University of California, San Francisco, California
| | - Tiffany Chong
- Department of Medicine, University of California, San Francisco, California
| | - Hilary Faust
- Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raja Rajalingam
- Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California, San Francisco, California
| | - Steven R Hays
- Department of Medicine, University of California, San Francisco, California
| | - Jeffrey A Golden
- Department of Medicine, University of California, San Francisco, California
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, California
| | - Jonathan P Singer
- Department of Medicine, University of California, San Francisco, California
| | - John R Greenland
- Department of Medicine, University of California, San Francisco, California.,Medical Service, Veterans Affairs Health Care System, San Francisco, California
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57
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Nguyen Y, Dodds T, Lowe P. Cutaneous Microsphaeropsis arundinis infection in renal transplant recipients-A report of 2 cases and review of the literature. JAAD Case Rep 2018; 4:415-417. [PMID: 29984267 PMCID: PMC6031487 DOI: 10.1016/j.jdcr.2017.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Yvonne Nguyen
- Sydney Medical School Central, The University of Sydney, Sydney, Australia.,Department of Dermatology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Tristan Dodds
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Patricia Lowe
- Sydney Medical School Central, The University of Sydney, Sydney, Australia.,Department of Dermatology, Royal Prince Alfred Hospital, Sydney, Australia
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58
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Launay M, Roux A, Beaumont L, Douvry B, Lecuyer L, Douez E, Picard C, Grenet D, Jullien V, Boussaud V, Guillemain R, Billaud EM. Posaconazole Tablets in Real-Life Lung Transplantation: Impact on Exposure, Drug-Drug Interactions, and Drug Management in Lung Transplant Patients, Including Those with Cystic Fibrosis. Antimicrob Agents Chemother 2018; 62:e02061-17. [PMID: 29311077 PMCID: PMC5826104 DOI: 10.1128/aac.02061-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/14/2017] [Indexed: 01/02/2023] Open
Abstract
Appropriate exposure to posaconazole (PSZ) has been limited until the recent approval of the delayed-release oral tablet formulation. Our goal was to determine the exposure obtained by using the standard dose of 300 mg once a day in lung transplant (LT) patients, including patients with cystic fibrosis (CF). PSZ trough concentrations (C0) were determined using a liquid chromatography-tandem mass spectrometry assay. Indicative thresholds of interest were <0.7 mg/liter for prophylaxis and 1 to 3 mg/liter for cure. The tacrolimus (TRL) and everolimus (ERL) C0 measured during PSZ exposure were also collected. The interaction with proton-pump inhibitors (PPI) was evaluated. We recorded the results for 21 CF patients with LT (CFLT patients), 11 non-CF patients with LT (NCFLT patients), and 27 nontransplant (NT) patients in pneumology departments. The weights of the NCFLT, CFLT, and NT patients were 59.2 ± 8.4, 48.8 ± 8.4, and 63.7 ± 16.6 kg, respectively (P = 0.001* [asterisk means that statistical test is significant]), and the PSZ C0 exposures for these patients were 1.9 ± 1.5, 1.1 ± 0.8, and 2.4 ± 1.8 mg/liter, respectively (P < 0.00001*). More than 60% of the concentrations were in the therapeutic range. In CFLT patients, the administration of one 300-mg PSZ tablet quickly achieved an exposure similar to that achieved with the PSZ oral suspension formulation (OSF) administered 3 or 4 times a day for several months. The TRL C0/dose ratio (C0/D) was 7.4 ± 4.4 mg/liter with PSZ tablets, whereas it was 4.6 ± 0.8 mg/liter with the PSZ oral solution (P = 0.034*). The ERL C0/D was similar with both formulations. PPI had no impact on the PSZ concentration (1.49 ± 1.07 mg/liter without PPI versus 1.33 ± 1.17 mg/liter with PPI; P = 0.4134*). Despite the high levels of exposure, PSZ remained well tolerated (one case of diarrhea and one case of fatigue were reported). PSZ tablet administration allows satisfactory exposure, even in CFLT patients, with a dosage lower than that of the PSZ OSF. This once-a-day formulation was not impacted by PPI, which are extensively used in CF patients.
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Affiliation(s)
- Manon Launay
- Laboratory of Pharmacology and Toxicology, European Hospital Georges Pompidou-APHP, Paris, France
| | - Antoine Roux
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Department, Foch Hospital, Suresnes, France
- Université Versailles Saint-Quentin, Versailles, France
| | - Laurence Beaumont
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Benoit Douvry
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Lucien Lecuyer
- Thoracic Transplantation, European Hospital Georges Pompidou-APHP, Paris, France
| | - Emmanuel Douez
- Laboratory of Pharmacology and Toxicology, European Hospital Georges Pompidou-APHP, Paris, France
| | - Clément Picard
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Dominique Grenet
- Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Department, Foch Hospital, Suresnes, France
| | - Vincent Jullien
- Laboratory of Pharmacology and Toxicology, European Hospital Georges Pompidou-APHP, Paris, France
| | - Véronique Boussaud
- Thoracic Transplantation, European Hospital Georges Pompidou-APHP, Paris, France
| | - Romain Guillemain
- Thoracic Transplantation, European Hospital Georges Pompidou-APHP, Paris, France
| | - Eliane M Billaud
- Laboratory of Pharmacology and Toxicology, European Hospital Georges Pompidou-APHP, Paris, France
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59
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Dheer D, Jyoti, Gupta PN, Shankar R. Tacrolimus: An updated review on delivering strategies for multifarious diseases. Eur J Pharm Sci 2018; 114:217-227. [DOI: 10.1016/j.ejps.2017.12.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/12/2017] [Accepted: 12/20/2017] [Indexed: 02/06/2023]
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60
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Kuypers DRJ. Tacrolimus Formulations and African American Kidney Transplant Recipients: When Do Details Matter? Am J Kidney Dis 2018; 71:302-305. [PMID: 29477174 DOI: 10.1053/j.ajkd.2017.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/15/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Dirk R J Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven; and Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.
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