Lower blood levels of isavuconazole in critically ill patients compared with other populations: possible need for therapeutic drug monitoring.
J Antimicrob Chemother
; 79(4): 835-845, 2024 04 02.
Article
en En
| MEDLINE
| ID: mdl-38366368
ABSTRACT
BACKGROUND:
Isavuconazole is first-line treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) is deemed not necessary, since most patients reached therapeutic levels (>1â mg/L) in large studies. Low levels were reported in some critically ill patients admitted to the ICU. The aim was to compare isavuconazole levels between critically ill and non-critically ill patients. MATERIALS ANDMETHODS:
Retrospective analysis of data from all patients treated with standard-dose isavuconazole between 1 January 2019 and 26 October 2022 was performed. The following data were collected TDM results from the first 30â days of therapy; ward of admission; demographic and clinical characteristics; continuous renal replacement therapy; extracorporeal membrane oxygenation; and co-administered drugs.RESULTS:
Seventy-two patients (median age 65â years) and 188 TDM measurements (mean number of samples per patient 2.6â±â1.7) were included; 33 (45.8%) were ICU patients (3 also had haematological disorders); 39 (54.2%) were non-ICU patients, of whom 31 had haematological disorders. In all patients, the mean isavuconazole blood level was 3.33â±â2.26â mg/L. Significantly lower levels were observed in the ICU versus the non-ICU population mean 2.02â±â1.22 versus 4.15â±â2.31â mg/L (Pâ<â0.001). Significantly higher rates of subtherapeutic levels were observed in ICU patients compared with the non-ICU population all determinations <2â mg/L in 33.3% versus 7.7%, and all determinations <1â mg/L in 12.1% versus 0%, respectively. Predictors of lower isavuconazole levels were admission to the ICU, BMIâ>â25â kg/m2, bilirubinâ>â1.2â mg/dL and the absence of haematological disorder.CONCLUSIONS:
ICU patients had significantly lower isavuconazole blood levels compared to non-ICU population. The TDM of isavuconazole for efficacy should be performed in ICU.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Piridinas
/
Monitoreo de Drogas
/
Enfermedad Crítica
/
Nitrilos
Límite:
Aged
/
Humans
Idioma:
En
Revista:
J Antimicrob Chemother
Año:
2024
Tipo del documento:
Article
País de afiliación:
Italia