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Berriri S, Zribi K, Gloulou O, Mokni Y, Safta F. Development, optimization and validation of an analytical method for the determination of voriconazole in plasma by high-performance liquid chromatography-ultraviolet detection: Application for comprehensive study. ANNALES PHARMACEUTIQUES FRANÇAISES 2024:S0003-4509(24)00069-5. [PMID: 38729517 DOI: 10.1016/j.pharma.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES Voriconazole is a widely used antifungal agent in clinical settings. However, its use has been associated with neurological side effects in some patients. For this reason, it is crucial to monitor its plasma levels to ensure that they are within the therapeutic range. Thus, in this study, we aimed to develop a simple, fast, and efficient method for the determination of voriconazole in plasma using reversed-phase HPLC-UV. We also aimed to validate the method for its application to routine analysis of immunocompromised patients. MATERIAL AND METHODS Plasma samples from immunocompromised patients were subjected to deproteinization with acetonitrile followed by centrifugation. Chromatographic separation was carried out on a C18 column with UV detection at 254nm in isocratic mode. The concentrations were calculated by comparing peak areas to those of the internal standard, ketoconazole. The method was validated using the accuracy profile, which uses a calibration curve established for the therapeutic range of 1 to 5.5μg/mL. RESULTS The developed method was proved to be rapid by giving a short analysis time for voriconazole at around 5.5min. Additionally, no interference with the biological matrix was detected. The obtained recoveries were higher than 90%. The accuracy profile showed that the method was accurate and precise for the determination of voriconazole in plasma. CONCLUSION The developed method was proved to be simple, efficient, that requires minimal sample preparation. Thus, it can be routinely applied for the therapeutic monitoring of voriconazole.
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Affiliation(s)
- Sarra Berriri
- Laboratory for the Chemical, Galenic and Pharmacological Development of Medicines LR12ES09, Faculty of pharmacy Monastir, avenue Ibn Sina, 5000 Monastir, Tunisia.
| | - Kaouther Zribi
- Laboratory for the Chemical, Galenic and Pharmacological Development of Medicines LR12ES09, Faculty of pharmacy Monastir, avenue Ibn Sina, 5000 Monastir, Tunisia
| | - Olfa Gloulou
- Pharmacy Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Yassine Mokni
- Laboratory for the Chemical, Galenic and Pharmacological Development of Medicines LR12ES09, Faculty of pharmacy Monastir, avenue Ibn Sina, 5000 Monastir, Tunisia
| | - Fathi Safta
- Laboratory for the Chemical, Galenic and Pharmacological Development of Medicines LR12ES09, Faculty of pharmacy Monastir, avenue Ibn Sina, 5000 Monastir, Tunisia
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Cheng L, Liu Z, Yu M, Lin L, Xiong L, Dai Q. Hypokalemia and Hyponatremia in Adult Patients Receiving Voriconazole Therapeutic Drug Monitoring. J Clin Pharmacol 2024; 64:461-468. [PMID: 37910022 DOI: 10.1002/jcph.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/31/2023] [Indexed: 11/03/2023]
Abstract
Hypokalemia and hyponatremia are common but easily ignored adverse events in treatment with voriconazole (VCZ) that can lead to serious consequences. We intend to investigate the incidence of VCZ-induced hypokalemia and hyponatremia and their risk factors based on real-world data. A prospective study was conducted. A total of 272 patients with 414 VCZ plasma trough concentrations (C0) and VCZ N-oxide concentrations (CN) were included. The incidence of hypokalemia was 18.0% (48/266). A total of 81.2% (39/48) of patients developed hypokalemia within 14 days, whereas 56.2% (27/48) of patients developed hypokalemia within 1 week. The proportion of female patients in the hypokalemia group was higher than that in the nonhypokalemia group, as was the proportion of patients receiving intravenous VCZ. In the multivariate analysis, the independent risk factors for hypokalemia were sex, combined use of antibiotics, and VCZ CN/C0. The incidence of hyponatremia was 7.9% (21/266). The proportion of patients over 47 years of age in the hyponatremia group was 71.4% (15/21). The number of days of VCZ use in the hyponatremia group was greater than that in the nonhyponatremia group. A total of 47.6% (10/21) of patients in the hyponatremia group had supratherapeutic VCZ C0 (>5.0 µg/mL). In conclusion, hypokalemia is more likely to occur in females, in patients receiving intravenous VCZ, and in patients with the combined use of antibiotics. Hyponatremia is more likely to occur in patients older than 47 years who have been using VCZ for a long time and have higher VCZ C0 values.
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Affiliation(s)
- Lin Cheng
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhirui Liu
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Mingjie Yu
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Ling Lin
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Lirong Xiong
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Qing Dai
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
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Cheng L, Zhao Y, Liang Z, You X, Jia C, Liu X, Wang Q, Sun F. Prediction of plasma trough concentration of voriconazole in adult patients using machine learning. Eur J Pharm Sci 2023; 188:106506. [PMID: 37356464 DOI: 10.1016/j.ejps.2023.106506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Plasma trough concentration of voriconazole (VCZ) was associated with its toxicity and efficacy. However, the nonlinear pharmacokinetic characteristics of VCZ make it difficult to determine the relationship between clinical characteristics and its concentration. We intended to present a machine learning (ML)-based method to predict toxic plasma trough concentration of VCZ (>5 μg/mL). METHODS A single center retrospective study was conducted. Three ML algorithms were used to estimate the concentration in adult patients, including random forest (RF), gradient boosting (GB), and extreme gradient boosting (XGBoost). The importance of variables was recognized by the SHapley Additive exPlanations (SHAP) method. In addition, an external validation set was used to validate the robustness of models. RESULTS A total of 1318 VCZ plasma concentration were included, with 33 variables enrolled in the model. Nine classification models were developed using the RF, GB, and XGBoost algorithms. Most models performed well for both the training set and test set, with an average balanced accuracy (BA) of 0.704 and an average accuracy (ACC) of 0.788. In addition, the average Matthews correlation coefficient value reached 0.484, which indicated the predicted values are meaningful. Based on the average BA and ACC values, the predictive ability of the models can be ranked from best to worst as follows: younger adult models > mixed models > elderly models, and XGBoost models > GBT models > RF models. The SHAP results showed that the top five influencing factors in younger adult patients (<60 years) were albumin, total bile acid (TBA), platelets count, age, and inflammation, while the top five influencing factors in elderly patients were albumin, TBA, aspartate aminotransferase, creatinine, and alanine aminotransferase. Furthermore, the prediction of external validation set for VCZ concentrations verified the high reliability of the models, for the ACC value of 0.822 by the best model. CONCLUSIONS The ML models can be reliable tools for predicting toxic concentration exposure of VCZ. The SHAP results may provide useful guidelines for dosage adjustment of VCZ.
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Affiliation(s)
- Lin Cheng
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Gao Tanyan Street 29#, Sha Pingba, Chongqing 400038, PR China
| | - Yue Zhao
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Gao Tanyan Street 29#, Sha Pingba, Chongqing 400038, PR China
| | - Zaiming Liang
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Gao Tanyan Street 29#, Sha Pingba, Chongqing 400038, PR China
| | - Xi You
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Gao Tanyan Street 29#, Sha Pingba, Chongqing 400038, PR China
| | - Changsheng Jia
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Gao Tanyan Street 29#, Sha Pingba, Chongqing 400038, PR China
| | - Xiuying Liu
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Gao Tanyan Street 29#, Sha Pingba, Chongqing 400038, PR China
| | - Qian Wang
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Gao Tanyan Street 29#, Sha Pingba, Chongqing 400038, PR China.
| | - Fengjun Sun
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Gao Tanyan Street 29#, Sha Pingba, Chongqing 400038, PR China.
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Cheng L, Liang Z, Liu F, Lin L, Zhang J, Xie L, Yu M, Sun F. Factors influencing plasma concentration of voriconazole and voriconazole- N-oxide in younger adult and elderly patients. Front Pharmacol 2023; 14:1126580. [PMID: 36860301 PMCID: PMC9969092 DOI: 10.3389/fphar.2023.1126580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
Background: Voriconazole (VCZ) metabolism is influenced by many factors. Identifying independent influencing factors helps optimize VCZ dosing regimens and maintain its trough concentration (C0) in the therapeutic window. Methods: We conducted a prospective study investigating independent factors influencing VCZ C0 and the VCZ C0 to VCZ N-oxide concentration ratio (C0/CN) in younger adults and elderly patients. A stepwise multivariate linear regression model, including the IL-6 inflammatory marker, was used. The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive effect of the indicator. Results: A total of 463 VCZ C0 were analyzed from 304 patients. In younger adult patients, the independent factors that influenced VCZ C0 were the levels of total bile acid (TBA) and glutamic-pyruvic transaminase (ALT) and the use of proton-pump inhibitors. The independent factors influencing VCZ C0/CN were IL-6, age, direct bilirubin, and TBA. The TBA level was positively associated with VCZ C0 (ρ = 0.176, p = 0.019). VCZ C0 increased significantly when the TBA levels were higher than 10 μmol/L (p = 0.027). ROC curve analysis indicated that when the TBA level ≥4.05 μmol/L, the incidence of a VCZ C0 greater than 5 μg/ml (95% CI = 0.54-0.74) (p = 0.007) increased. In elderly patients, the influencing factors of VCZ C0 were DBIL, albumin, and estimated glomerular filtration rate (eGFR). The independent factors that affected VCZ C0/CN were eGFR, ALT, γ-glutamyl transferase, TBA, and platelet count. TBA levels showed a positive association with VCZ C0 (ρ = 0.204, p = 0.006) and C0/CN (ρ = 0.342, p < 0.001). VCZ C0/CN increased significantly when TBA levels were greater than 10 μmol/L (p = 0.025). ROC curve analysis indicated that when the TBA level ≥14.55 μmol/L, the incidence of a VCZ C0 greater than 5 μg/ml (95% CI = 0.52-0.71) (p = 0.048) increased. Conclusion: TBA level may serve as a novel marker for VCZ metabolism. eGFR and platelet count should also be considered when using VCZ, especially in elderly patients.
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Affiliation(s)
| | | | - Fang Liu
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University, Third Military Medical University, Chongqing, China
| | - Ling Lin
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University, Third Military Medical University, Chongqing, China
| | - Jiao Zhang
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University, Third Military Medical University, Chongqing, China
| | - Linli Xie
- Department of Pharmacy, The First Affiliated Hospital of Army Medical University, Third Military Medical University, Chongqing, China
| | - Mingjie Yu
- *Correspondence: Mingjie Yu, ; Fengjun Sun,
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Boglione-Kerrien C, Morcet J, Scailteux LM, Bénézit F, Camus C, Mear JB, Gangneux JP, Bellissant E, Tron C, Verdier MC, Lemaitre F. Contribution of voriconazole N-oxide plasma concentration measurements to voriconazole therapeutic drug monitoring in patients with invasive fungal infection. Mycoses 2023; 66:396-404. [PMID: 36698317 DOI: 10.1111/myc.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Voriconazole (VRC), a widely used triazole antifungal, exhibits significant inter- and intra-individual pharmacokinetic variability. The main metabolite voriconazole N-oxide (NOX) can provide information on the patient's drug metabolism capacity. OBJECTIVES Our objectives were to implement routine measurement of NOX concentrations and to describe the metabolic ratio (MR), and the contribution of the MR to VRC therapeutic drug monitoring (TDM) by proposing a suggested dosage-adjustment algorithm. PATIENTS AND METHODS Sixty-one patients treated with VRC were prospectively included in the study, and VRC and NOX levels were assayed by LC-MS/MS. A mixed logistic model on repeated measures was implemented to analyse risk factors for the patient's concentration to be outside the therapeutic range. RESULTS Based on 225 measurements, the median and interquartile range were 2.4 μg/ml (1.2; 4.2), 2.1 μg/ml (1.5; 3.0) and 1.0 (0.6; 1.9) for VRC, NOX and the MR, respectively. VRC Cmin <2 μg/ml were associated with a higher MR during the previous visit. MR values >1.15 and <0.48 were determined to be the best predictors for having a VRC Cmin lower than 2 μg/ml and above 5.5 μg/ml, respectively, at the next visit. CONCLUSIONS Measurement of NOX resulted useful for TDM of patients treated with VRC. The MR using NOX informed interpretation and clinical decision-making and is very interesting for complex patients. VRC phenotyping based on the MR is now performed routinely in our institution. A dosing algorithm has been suggested from these results.
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Affiliation(s)
| | - Jeff Morcet
- Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Lucie-Marie Scailteux
- Department of Clinical Pharmacology, Rennes University Hospital, Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Rennes, France
| | - François Bénézit
- Department of Infectious Diseases, Rennes University Hospital, Rennes, France
| | - Christophe Camus
- Department of Intensive Care Medicine, Rennes University Hospital, Rennes, France
| | - Jean-Baptiste Mear
- Department of Clinical Haematology, Rennes University Hospital, Rennes, France
| | - Jean-Pierre Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - Eric Bellissant
- Department of Biological Pharmacology, CHU Rennes, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Camille Tron
- Department of Biological Pharmacology, CHU Rennes, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Marie-Clémence Verdier
- Department of Biological Pharmacology, CHU Rennes, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
| | - Florian Lemaitre
- Department of Biological Pharmacology, CHU Rennes, Rennes, France.,Inserm, CIC-P 1414 Clinical Investigation Centre, Rennes, France
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Cheng L, Liang Z, You X, Jia C, Liu Z, Sun F. The Role of the Mesencephalic Astrocyte-Derived Neurotrophic Factor in Patients in Intensive Care Units Receiving Voriconazole Therapy. J Clin Pharmacol 2023; 63:604-612. [PMID: 36609957 DOI: 10.1002/jcph.2201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Recent publications regarding the role of mesencephalic astrocyte-derived neurotrophic factor (MANF) in various metabolic and degenerative disorders suggest that MANF is both a marker of disease and a possible therapeutic agent. We investigate the role of plasma MANF levels in patients in intensive care units (ICUs) receiving voriconazole (VCZ) therapy while also comparing MANF levels in healthy individuals. A single-center prospective study was conducted. The plasma MANF level in patients in ICU was found to have high interindividual variability and was significantly higher than that in healthy controls (P < .01). Compared with patients using VCZ only, patients using both VCZ and amikacin had 3-fold lower MANF concentrations (P < .05). The MANF concentrations also decreased when alkaline phosphatase (ALP) and serum creatinine levels were above the upper limits of the normal range (P < .05) and the estimated glomerular filtration rate (eGFR) was below the lower limit of the normal range (P < .01). Receiver operating characteristic curve analysis indicated that low MANF levels were associated with high ALP levels, high creatinine levels, and low eGFR. The cut-off value of MANF for ALP levels higher than 126 U/L was 0.35 ng/mL (area under curve, AUC = 0.62, 95%CI = 0.50-0.74, P = .044); for serum creatinine levels higher than 104 μmol/L, the cut-off value was 0.41 ng/mL (AUC = 0.74, 95%CI = 0.62-0.87, P = .001); and for eGFR below 80 mL/min, the cut-off value was 0.75 ng/mL (AUC = 0.70, 95%CI = 0.59-0.81, P = .002). Monitoring plasma MANF levels may be of value for clinical decision-making regarding the choice of antibiotics and the prediction of impaired liver function and renal function in patients admitted to an ICU.
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Affiliation(s)
- Lin Cheng
- Department of Pharmacy, The First Affiliated Hospital of the Army Medical University (Third Military Medical University), Chongqing, China
| | - Zaiming Liang
- Department of Pharmacy, The First Affiliated Hospital of the Army Medical University (Third Military Medical University), Chongqing, China
| | - Xi You
- Department of Pharmacy, The First Affiliated Hospital of the Army Medical University (Third Military Medical University), Chongqing, China
| | - Changsheng Jia
- Department of Pharmacy, The First Affiliated Hospital of the Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhirui Liu
- Department of Pharmacy, The First Affiliated Hospital of the Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengjun Sun
- Department of Pharmacy, The First Affiliated Hospital of the Army Medical University (Third Military Medical University), Chongqing, China
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Liang Z, Yu M, Liu Z, Liu F, Jia C, Xiong L, Dai Q, Qin S, Cheng L, Sun F. Inflammation Affects Liver Function and the Metabolism of Voriconazole to Voriconazole-N-Oxide in Adult and Elderly Patients. Front Pharmacol 2022; 13:835871. [PMID: 35462904 PMCID: PMC9019686 DOI: 10.3389/fphar.2022.835871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The inner association of inflammation with voriconazole (VCZ) metabolism has not been fully investigated. We intend to investigate the effects of inflammation on liver function, VCZ trough concentration (C0), C0/dose ratio and the ratio of VCZ to VCZ-N-oxide concentration (C0/CN) in adult and elderly patients. Methods: A single-center retrospective study was conducted among patients who were treated in our hospital between January 2018 and December 2021. For each eligible patient, demographic details, medical history, laboratory parameters, procalcitonin (PCT), C reactive protein (CRP), and interleukin-6 (IL-6) were collected from the medical chart. VCZ CN, TNF-α, IL-1β, IL-8, and IL-10 concentrations were detected in blood samples. Results: A total of 356 patients were included in our study, with 195 patients in the adult cohort (<60 years) and 161 patients in the elderly cohort (≥60 years). In adult patients, CRP and IL-8 levels showed moderate association with VCZ C0/CN ratio (CRP: r = 0.512, p < 0.001; IL-8: r = 0.476, p = 0.002). IL-6 level shallowly associated with VCZ C0/CN ratio both in adult and elderly patients (r = 0.355, p = 0.003; r = 0.386, p = 0.001). A significantly higher VCZ C0, C0/dose ratio and C0/CN ratio was observed in adult patients with severe inflammation compared with patients with moderate inflammation and no to mild inflammation, as reflected by PCT levels (p < 0.05). However, there was no significant difference observed among different inflammation degrees in elderly patients. Lower albumin (AL) and higher total bilirubin (TBIL) were observed along with the degree of inflammation in both adult and elderly patients, as reflected by CRP and PCT levels (p < 0.05). Conclusion: Inflammation may affect the metabolism of VCZ to VCZ-N-oxide both in adult and elderly patients, and decreased plasma AL levels and increased TBIL levels under inflammatory conditions may also alter VCZ metabolism.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lin Cheng
- *Correspondence: Lin Cheng, ; Fengjun Sun,
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Zhang Y, Hou K, Liu F, Luo X, He S, Hu L, Yang C, Huang L, Feng Y. The influence of CYP2C19 polymorphisms on voriconazole trough concentrations: Systematic review and meta-analysis. Mycoses 2021; 64:860-873. [PMID: 33896064 DOI: 10.1111/myc.13293] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/10/2021] [Accepted: 04/15/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Voriconazole primary metabolism is catalysed by CYP2C19. A large variability of trough concentrations in patients with invasive fungal infection treated with voriconazole has been observed in clinical practice. It remains controversial whether the CYP2C19 polymorphisms are responsible for voriconazole metabolism in the individual variation. OBJECTIVES The primary aim of this study was to assess the effect of CYP2C19 polymorphisms on voriconazole trough concentrations. METHODS Following a systematic literature review, we performed a meta-analysis for mean differences (MD) of voriconazole trough concentrations (Cmin ), voriconazole dosage adjusted trough concentrations (Cmin /D) and for risk ratio (RR) of the proportion of patients in the target therapeutic range between pairwise comparisons of CYP2C19 phenotypes. RESULTS Compared with normal metabolisers (NMs), intermediate metabolisers (IMs) (MD: 0.82, 95% CI: 0.57 to 1.07, I2 = 44%, p < .00001) or poor metabolisers (PMs) (MD: 1.59, 95% CI: 1.14 to 2.05, I2 = 46%, p < .00001) had significantly higher voriconazole Cmin (μg·ml-1 ), while rapid metabolisers (RMs) had significantly lower voriconazole Cmin (MD: -0,87, 95% CI: -1.35 to -0.38, I2 = 0%, p = .0004). In addition, IMs had significantly lower Cmin than PMs (MD: -0.59, 95% CI: -0.97 to -0.20, I2 = 22%, p = .003). Similarly, the Cmin /D (μg·kg·ml-1 ·mg-1 ) was significantly higher in IMs (MD: 0.13, 95% CI: 0.05 to 0.22, I2 = 0%, p = .002) and PMs (MD: 0.20, 95% CI: 0.07 to 0.34, I2 = 0%, p = .003) than that in NMs, and also, IMs had significantly lower Cmin /D than PMs (MD: -0.11, 95% CI: -0.14 to -0.08, I2 = 0%, p < .00001). Furthermore, PMs had a significantly higher proportion of the target therapeutic range than NMs (RR: 1.34, 95% CI: 1.09 to 1.64, I2 = 50%, p = .005). CONCLUSIONS Compared to NMs, IMs and PMs had higher voriconazole trough concentrations, especially in Asians, while RMs had lower voriconazole trough concentrations. In addition, PMs had a higher proportion of the target therapeutic range than NMs, especially in Asians. CYP2C19 genotyping is expected to be used to preemptively guide the individualisation of voriconazole in clinical practice.
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Affiliation(s)
- Ying Zhang
- Department of Pharmacy, Peking University People's Hospital, Beijing, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Kelu Hou
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Fang Liu
- Department of Mathematics and Physics, School of Chinese Pharmacy, Beijing University of Chinese Medicine, Beijing, China
| | - Xingxian Luo
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Shiyu He
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Lei Hu
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Changqing Yang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Lin Huang
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Yufei Feng
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
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Rapid and Simple Reversed-Phase High-Performance Liquid Chromatography (RP-HPLC) Method for Simultaneous Quantifications of Triazole Antifungals in Human Serum. Mycopathologia 2021; 186:27-39. [PMID: 33389486 DOI: 10.1007/s11046-020-00514-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/25/2020] [Indexed: 10/20/2022]
Abstract
PURPOSE To develop and validate a one-step, rapid and simple reversed-phase high-performance liquid chromatography (HPLC)-based protocol for the simultaneous measurement of voriconazole (VCZ), posaconazole (POSA), itraconazole (ITC) in serum/plasma. METHODS Calibration standards (CS) and quality control samples were prepared in drug-free serum by spiking with the triazoles at different concentrations. HPLC was performed with C18 column, isocratic mobile phase after extraction with cold acetonitrile. The standardized method was tested in 2693 patients' serum/plasma samples. RESULTS Linearity of CS for ITC, VCZ and POSA was proportional to the nominal concentration (correlation coefficient > 0.999). Limit of detection (mg/L) for ITC, VCZ and POSA was 0.25, 0.25 and 0.125, respectively. The lower limit of quantification (mg/L) for ITC, VCZ and POSA was 0.5, 0.5 and 0.25, respectively. Precision and accuracy were in acceptable range with 100% average percentage recovery. No interferences from endogenous substances and other antimicrobial compounds were noted. In clinical samples, the therapeutic range achieved for VCZ was 39.9%. Whereas, 61.1% and 44% of samples with ITC and POSA, respectively, were in the sub-therapeutic range. CONCLUSION We developed a rapid and simple HPLC method to quantify common triazoles in a single chromatographic run allowing simultaneous measurement of different antifungals in a small volume of serum/plasma. Thus, therapeutic drug monitoring requests can be processed in one run without changing the protocol parameters, column or column conditioning thereby improving turnaround time.
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Chuwongwattana S, Jantararoungtong T, Prommas S, Medhasi S, Puangpetch A, Sukasem C. Impact of CYP2C19, CYP3A4, ABCB1, and FMO3 genotypes on plasma voriconazole in Thai patients with invasive fungal infections. Pharmacol Res Perspect 2020; 8:e00665. [PMID: 33124772 PMCID: PMC7596670 DOI: 10.1002/prp2.665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/06/2020] [Accepted: 09/10/2020] [Indexed: 12/20/2022] Open
Abstract
Voriconazole is the first-line antifungal choice in the treatment of invasive fungal infections (IFIs). Single nucleotide polymorphisms (SNPs) in drug-metabolizing and transporter genes may affect voriconazole pharmacokinetics. This study aimed to determine the frequency of the CYP2C19 rs4244285, rs4986893, rs72552267, and rs12248560, CYP3A4 rs4646437, ABCB1 rs1045642, and FMO3 rs2266782 alleles and determine the association between these genetic variants and voriconazole concentrations in Thai patients with invasive fungal infections. The study comprised 177 Thai patients with IFIs in whom seven SNPs in CYP2C19, CYP3A4, ABCB1, and FMO3 were genotyped using TaqMan real-time polymerase chain reaction (RT-PCR) 5´ nuclease assays, and voriconazole plasma concentrations were measured by high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). Of the 177 patients included, 31 were <12 years and 146 were ≥12 years. The CYP2C19 allele frequencies were 0.29 for *2, 0.060 for *3, 0.003 for *6, and 0.008 for *17. The allele frequency of CYP3A4 (rs4646437) was 0.26, ABCB1 (rs1045642) was 0.36, and FMO3 (rs2266782) was 0.16. The median voriconazole dose/weight was significantly lower in patients aged ≥12 years when compared to the patients aged <12 years (P < .001). Patients aged <12 years with CYP2C19*1/*2 exhibited significantly higher median voriconazole plasma concentrations than those with the CYP2C19*1/*1 (P = .038). However, there were no significant differences in median voriconazole plasma concentrations among the CYP2C19 genotypes in the patients aged ≥12 years. There was a lack of association observed among the CYP3A4, ABCB1, and FMO3 genotypes on the plasma voriconazole concentrations in both groups of patients. Our findings indicate that voriconazole plasma concentrations are affected by the CYP2C19*2 allele in patients aged <12 years but not in patients aged ≥12 years.
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Affiliation(s)
- Sumonrat Chuwongwattana
- Division of Pharmacogenomics and Personalized MedicineDepartment of PathologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
- Laboratory for PharmacogenomicsSomdech Phra Debaratana Medical Center (SDMC)Ramathibodi HospitalBangkokThailand
| | - Thawinee Jantararoungtong
- Division of Pharmacogenomics and Personalized MedicineDepartment of PathologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
- Laboratory for PharmacogenomicsSomdech Phra Debaratana Medical Center (SDMC)Ramathibodi HospitalBangkokThailand
| | - Santirat Prommas
- Division of Pharmacogenomics and Personalized MedicineDepartment of PathologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
- Laboratory for PharmacogenomicsSomdech Phra Debaratana Medical Center (SDMC)Ramathibodi HospitalBangkokThailand
| | - Sadeep Medhasi
- Center for Medical GenomicsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Apichaya Puangpetch
- Division of Pharmacogenomics and Personalized MedicineDepartment of PathologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
- Laboratory for PharmacogenomicsSomdech Phra Debaratana Medical Center (SDMC)Ramathibodi HospitalBangkokThailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized MedicineDepartment of PathologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
- Laboratory for PharmacogenomicsSomdech Phra Debaratana Medical Center (SDMC)Ramathibodi HospitalBangkokThailand
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