Posaconazole therapeutic drug monitoring in clinical practice and longitudinal analysis of the effect of routine laboratory measurements on posaconazole concentrations

Anne Grete Märtson, Anette Veringa, Edwin R. van den Heuvel, Martijn Bakker, Daan J. Touw, Tjip S. van der Werf, Lambert F.R. Span, Jan Willem C. Alffenaar (Corresponding author)

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Uittreksel

Posaconazole is indicated for prophylaxis and treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) of posaconazole is used to optimise drug exposure. The aim of this study was to analyse and describe the TDM practices and exposure of posaconazole tablets. Patients who received posaconazole for treatment or prophylaxis of fungal infections were included in the study. The following therapeutic window was defined: if concentration was low (<0.7 mg/L for prophylaxis or < 1.5 mg/L for treatment) or high (>3.75 mg/L), the hospital pharmacist provided the physician with dosage advice, which implementation to patient care was analysed. A longitudinal analysis was performed to analyse if different confounding variables had an effect on posaconazole concentrations. Forty-seven patients were enrolled resulting in 217 posaconazole trough concentrations. A median of 3 (IQR 1-7) samples was measured per patient. The median concentration was 1.7 mg/L (IQR 0.8-2.7) for prophylaxis and 1.76 mg/L (IQR 1.3-2.3) for treatment. Overall, 78 posaconazole concentrations were out of the therapeutic window. For 45 (54%) of these concentrations, a dosage change was recommended. In the longitudinal analysis, the laboratory markers and patient baseline variables did not have an effect on posaconazole concentrations. Adequate posaconazole exposure was shown in 64% (affected 28 patients) of the measured concentrations. TDM practice of posaconazole can be improved by increasing the implementation rate of dose recommendation by a multidisciplinary antifungal stewardship team.

TaalEngels
Pagina's698-705
TijdschriftMycoses
Volume62
Nummer van het tijdschrift8
Vroegere onlinedatum30 mei 2019
DOI's
StatusGepubliceerd - 15 jul 2019

Vingerafdruk

Drug Monitoring
Therapeutics
posaconazole
Aspergillosis
Confounding Factors (Epidemiology)
Mycoses
Pharmacists
Tablets
Patient Care
Biomarkers
Physicians

Trefwoorden

    Citeer dit

    Märtson, Anne Grete ; Veringa, Anette ; van den Heuvel, Edwin R. ; Bakker, Martijn ; Touw, Daan J. ; van der Werf, Tjip S. ; Span, Lambert F.R. ; Alffenaar, Jan Willem C./ Posaconazole therapeutic drug monitoring in clinical practice and longitudinal analysis of the effect of routine laboratory measurements on posaconazole concentrations. In: Mycoses. 2019 ; Vol. 62, Nr. 8. blz. 698-705
    @article{1d9acac51a6e42afbaf69e78b5893971,
    title = "Posaconazole therapeutic drug monitoring in clinical practice and longitudinal analysis of the effect of routine laboratory measurements on posaconazole concentrations",
    abstract = "Posaconazole is indicated for prophylaxis and treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) of posaconazole is used to optimise drug exposure. The aim of this study was to analyse and describe the TDM practices and exposure of posaconazole tablets. Patients who received posaconazole for treatment or prophylaxis of fungal infections were included in the study. The following therapeutic window was defined: if concentration was low (<0.7 mg/L for prophylaxis or < 1.5 mg/L for treatment) or high (>3.75 mg/L), the hospital pharmacist provided the physician with dosage advice, which implementation to patient care was analysed. A longitudinal analysis was performed to analyse if different confounding variables had an effect on posaconazole concentrations. Forty-seven patients were enrolled resulting in 217 posaconazole trough concentrations. A median of 3 (IQR 1-7) samples was measured per patient. The median concentration was 1.7 mg/L (IQR 0.8-2.7) for prophylaxis and 1.76 mg/L (IQR 1.3-2.3) for treatment. Overall, 78 posaconazole concentrations were out of the therapeutic window. For 45 (54{\%}) of these concentrations, a dosage change was recommended. In the longitudinal analysis, the laboratory markers and patient baseline variables did not have an effect on posaconazole concentrations. Adequate posaconazole exposure was shown in 64{\%} (affected 28 patients) of the measured concentrations. TDM practice of posaconazole can be improved by increasing the implementation rate of dose recommendation by a multidisciplinary antifungal stewardship team.",
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    author = "M{\"a}rtson, {Anne Grete} and Anette Veringa and {van den Heuvel}, {Edwin R.} and Martijn Bakker and Touw, {Daan J.} and {van der Werf}, {Tjip S.} and Span, {Lambert F.R.} and Alffenaar, {Jan Willem C.}",
    year = "2019",
    month = "7",
    day = "15",
    doi = "10.1111/myc.12948",
    language = "English",
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    journal = "Mycoses",
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    Posaconazole therapeutic drug monitoring in clinical practice and longitudinal analysis of the effect of routine laboratory measurements on posaconazole concentrations. / Märtson, Anne Grete; Veringa, Anette; van den Heuvel, Edwin R.; Bakker, Martijn; Touw, Daan J.; van der Werf, Tjip S.; Span, Lambert F.R.; Alffenaar, Jan Willem C. (Corresponding author).

    In: Mycoses, Vol. 62, Nr. 8, 15.07.2019, blz. 698-705.

    Onderzoeksoutput: Bijdrage aan tijdschriftArtikel recenserenAcademicpeer review

    TY - JOUR

    T1 - Posaconazole therapeutic drug monitoring in clinical practice and longitudinal analysis of the effect of routine laboratory measurements on posaconazole concentrations

    AU - Märtson,Anne Grete

    AU - Veringa,Anette

    AU - van den Heuvel,Edwin R.

    AU - Bakker,Martijn

    AU - Touw,Daan J.

    AU - van der Werf,Tjip S.

    AU - Span,Lambert F.R.

    AU - Alffenaar,Jan Willem C.

    PY - 2019/7/15

    Y1 - 2019/7/15

    N2 - Posaconazole is indicated for prophylaxis and treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) of posaconazole is used to optimise drug exposure. The aim of this study was to analyse and describe the TDM practices and exposure of posaconazole tablets. Patients who received posaconazole for treatment or prophylaxis of fungal infections were included in the study. The following therapeutic window was defined: if concentration was low (<0.7 mg/L for prophylaxis or < 1.5 mg/L for treatment) or high (>3.75 mg/L), the hospital pharmacist provided the physician with dosage advice, which implementation to patient care was analysed. A longitudinal analysis was performed to analyse if different confounding variables had an effect on posaconazole concentrations. Forty-seven patients were enrolled resulting in 217 posaconazole trough concentrations. A median of 3 (IQR 1-7) samples was measured per patient. The median concentration was 1.7 mg/L (IQR 0.8-2.7) for prophylaxis and 1.76 mg/L (IQR 1.3-2.3) for treatment. Overall, 78 posaconazole concentrations were out of the therapeutic window. For 45 (54%) of these concentrations, a dosage change was recommended. In the longitudinal analysis, the laboratory markers and patient baseline variables did not have an effect on posaconazole concentrations. Adequate posaconazole exposure was shown in 64% (affected 28 patients) of the measured concentrations. TDM practice of posaconazole can be improved by increasing the implementation rate of dose recommendation by a multidisciplinary antifungal stewardship team.

    AB - Posaconazole is indicated for prophylaxis and treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) of posaconazole is used to optimise drug exposure. The aim of this study was to analyse and describe the TDM practices and exposure of posaconazole tablets. Patients who received posaconazole for treatment or prophylaxis of fungal infections were included in the study. The following therapeutic window was defined: if concentration was low (<0.7 mg/L for prophylaxis or < 1.5 mg/L for treatment) or high (>3.75 mg/L), the hospital pharmacist provided the physician with dosage advice, which implementation to patient care was analysed. A longitudinal analysis was performed to analyse if different confounding variables had an effect on posaconazole concentrations. Forty-seven patients were enrolled resulting in 217 posaconazole trough concentrations. A median of 3 (IQR 1-7) samples was measured per patient. The median concentration was 1.7 mg/L (IQR 0.8-2.7) for prophylaxis and 1.76 mg/L (IQR 1.3-2.3) for treatment. Overall, 78 posaconazole concentrations were out of the therapeutic window. For 45 (54%) of these concentrations, a dosage change was recommended. In the longitudinal analysis, the laboratory markers and patient baseline variables did not have an effect on posaconazole concentrations. Adequate posaconazole exposure was shown in 64% (affected 28 patients) of the measured concentrations. TDM practice of posaconazole can be improved by increasing the implementation rate of dose recommendation by a multidisciplinary antifungal stewardship team.

    KW - clinical pharmacy

    KW - haematological malignancies

    KW - invasive fungal infections

    KW - longitudinal analysis

    KW - pharmacist

    KW - pharmacokinetics

    KW - posaconazole

    KW - therapeutic drug monitoring

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    U2 - 10.1111/myc.12948

    DO - 10.1111/myc.12948

    M3 - Review article

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    JO - Mycoses

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