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The relationship between the success rate of empirical antifungal therapy with intravenous itraconazole and clinical parameters, including plasma levels of itraconazole, in immunocompromised patients receiving itraconazole oral solution as prophylaxis: a multicenter, prospective, open-label, observational study in Korea

Authors
 Jin Seok Kim  ;  June-Won Cheong  ;  Yeo-Kyeoung Kim  ;  Jinny Park  ;  Yeung-Chul Mun  ;  Hye Jin Kang  ;  Hyeon Gyu Yi  ;  Je-Hwan Lee  ;  Yang Soo Kim  ;  Hun-Mo Ryoo  ;  Sung-Hyun Kim  ;  Ho Young Kim  ;  Jin Young Kim  ;  Dong-Gun Lee  ;  Hoon-Gu Kim  ;  Hawk Kim  ;  Young-Don Joo  ;  Yoo Hong Min 
Citation
 ANNALS OF HEMATOLOGY, Vol.93(1) : 33-42, 2014 
Journal Title
 ANNALS OF HEMATOLOGY 
ISSN
 0939-5555 
Issue Date
2014
MeSH
Administration, Oral ; Adult ; Aged ; Aged, 80 and over ; Antifungal Agents/administration & dosage ; Antifungal Agents/adverse effects ; Antifungal Agents/blood ; Antifungal Agents/therapeutic use* ; Chemotherapy-Induced Febrile Neutropenia/complications ; Drug Monitoring ; Female ; Hematologic Neoplasms/complications ; Humans ; Itraconazole/administration & dosage ; Itraconazole/adverse effects ; Itraconazole/analogs & derivatives ; Itraconazole/blood ; Itraconazole/therapeutic use* ; Male ; Middle Aged ; Mycoses/drug therapy* ; Mycoses/etiology ; Mycoses/prevention & control ; Prospective Studies ; Treatment Outcome ; Young Adult
Keywords
Hematological malignancy ; itraconazole ; Hydroxy itraconazole ; Empirical antifungal therapy ; Therapeutic drug monitoring
Abstract
To identify the role of therapeutic drug monitoring of itraconazole (ITZ) in the setting of empirical antifungal therapy with intravenous (IV) ITZ, we performed a multicenter, prospective study in patients with hematological malignancies who had received antifungal prophylaxis with ITZ oral solution (OS). We evaluated the plasma levels of ITZ and hydroxy (OH) ITZ both before initiation of IV ITZ and on days 5–7 of IV ITZ. A total of 181 patients showed an overall success rate of 68.0 %. Prolonged baseline neutropenia and accompanying cardiovascular comorbidity were significantly associated with poor outcomes of the empirical antifungal therapy (P = 0.005 and P = 0.001, respectively). A significantly higher trough plasma level of OH ITZ per body weight was found in the patients who achieved success with empirical antifungal therapy (P = 0.036). There were no significant correlations between plasma concentrations of ITZ/OH ITZ (baseline or trough levels) and toxicities. Seven patients had a discontinuation of ITZ therapy due to toxicity. This study demonstrated that IV ITZ as empirical antifungal therapy was effective and therapeutic drug monitoring was helpful to estimate the outcome of empirical antifungal therapy in patients receiving antifungal prophylaxis with ITZ OS. To predict the outcome of empirical antifungal therapy with IV ITZ, we should evaluate baseline clinical characteristics and also perform the therapeutic drug monitoring of both ITZ and OH ITZ.
Full Text
http://link.springer.com/article/10.1007%2Fs00277-013-1826-x
DOI
10.1007/s00277-013-1826-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jin Seok(김진석) ORCID logo https://orcid.org/0000-0001-8986-8436
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
Cheong, June-Won(정준원) ORCID logo https://orcid.org/0000-0002-1744-0921
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98021
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