{"title":"Therapeutic Drug Monitoring of Voriconazole: Unbound Concentration With Clinical Efficacy and Adverse Events.","authors":"Tiantian Zhang, Zhicong Qiu, Wenhao Chu, Wenli Li, Xikun Wu, Yuxin Wang, Yishuo Zhai, Wei Zhang, Zhiqing Zhang","doi":"10.1177/10600280251352876","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Voriconazole is widely used for patients with fungal infections, but the correlations between the unbound concentration (C<sub>free</sub>) of voriconazole in plasma and clinical outcomes remains unclear.</p><p><strong>Objective: </strong>The aim of this study was to analyze the correlation between C<sub>free</sub> and clinical outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted at the Second Hospital of Hebei Medical University from February 2021 to March 2024 (Shijiazhuang, China). Patients who received voriconazole with at least one measured concentration in our center were enrolled. Based on determined the C<sub>free</sub> of voriconazole, factors that might affect C<sub>free</sub> were analyzed in conjunction with patient characteristics, and the correlations between voriconazole C<sub>free</sub> and the clinical efficacy as well as AEs in patients were investigated.</p><p><strong>Results: </strong>A total of 60 blood samples were collected from 56 patients. Voriconazole C<sub>free</sub> was positive correlation with creatinine, while negative correlation with creatinine clearance. The C<sub>free</sub> of patients in the clinical effective group was significantly higher than that in the clinical ineffective group, and the C<sub>free</sub> of patients in the group with AEs was significantly higher than that in the group without AEs (<i>P</i> = 0.006, 0.025). Voriconazole C<sub>free</sub> (odds ratio [OR] = 2.617, 95% confidence interval [CI]:1.142-6.000, <i>P</i> = 0.023) and albumin level (OR = 1.085, 95% CI: 1.000-1.177, <i>P</i> = 0.050) were independent influencing factors of clinical efficacy, the receiver operating characteristic (ROC) cut off for C<sub>free</sub> and efficacy was 0.8 μg·mL<sup>-1</sup>. Voriconazole C<sub>free</sub> (OR = 1.979, 95% CI: 1.008-3.888, <i>P</i> = 0.048) was an independent risk factor for AEs, the ROC cut off for C<sub>free</sub> and AEs was 1.2 μg·mL<sup>-1</sup>.</p><p><strong>Conclusions and relevance: </strong>Voriconazole C<sub>free</sub> was positively correlated with clinical efficacy and the incidence of AEs in patients.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251352876"},"PeriodicalIF":2.3000,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Pharmacotherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10600280251352876","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Voriconazole is widely used for patients with fungal infections, but the correlations between the unbound concentration (Cfree) of voriconazole in plasma and clinical outcomes remains unclear.
Objective: The aim of this study was to analyze the correlation between Cfree and clinical outcomes.
Methods: A retrospective analysis was conducted at the Second Hospital of Hebei Medical University from February 2021 to March 2024 (Shijiazhuang, China). Patients who received voriconazole with at least one measured concentration in our center were enrolled. Based on determined the Cfree of voriconazole, factors that might affect Cfree were analyzed in conjunction with patient characteristics, and the correlations between voriconazole Cfree and the clinical efficacy as well as AEs in patients were investigated.
Results: A total of 60 blood samples were collected from 56 patients. Voriconazole Cfree was positive correlation with creatinine, while negative correlation with creatinine clearance. The Cfree of patients in the clinical effective group was significantly higher than that in the clinical ineffective group, and the Cfree of patients in the group with AEs was significantly higher than that in the group without AEs (P = 0.006, 0.025). Voriconazole Cfree (odds ratio [OR] = 2.617, 95% confidence interval [CI]:1.142-6.000, P = 0.023) and albumin level (OR = 1.085, 95% CI: 1.000-1.177, P = 0.050) were independent influencing factors of clinical efficacy, the receiver operating characteristic (ROC) cut off for Cfree and efficacy was 0.8 μg·mL-1. Voriconazole Cfree (OR = 1.979, 95% CI: 1.008-3.888, P = 0.048) was an independent risk factor for AEs, the ROC cut off for Cfree and AEs was 1.2 μg·mL-1.
Conclusions and relevance: Voriconazole Cfree was positively correlated with clinical efficacy and the incidence of AEs in patients.
期刊介绍：
Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
