Remission of hepatotoxicity in chronic pulmonary aspergillosis patients after lowering trough concentration of voriconazole  

作　　者：Guo-Jie Teng Xiang-Rong Bai Lin Zhang Hong-Jun Liu Xiu-Hong Nie 

机构地区：[1]Department of Pulmonary and Critical Care Medicine,Xuanwu Hospital Capital Medical University,Beijing 100053,China [2]Pharmacy Department,Xuanwu Hospital Capital Medical University,Beijing 100053,China [3]Department of Evidence-based Medicine,Xuanwu Hospital Capital Medical University,Beijing,China,Beijing 100053,China

出　　处：《World Journal of Clinical Cases》2020年第20期4700-4707,共8页世界临床病例杂志

摘　　要：BACKGROUND Chronic pulmonary aspergillosis(CPA)is a rare syndrome that is often accompanied by gradual lung tissue destruction.Voriconazole is usually employed as the first-line agent for CPA treatment.However,some patients can develop hepatotoxicity and often were forced to stop voriconazole treatment.AIM To record the improving trend of liver function and the therapeutic effects in patients after lowering the trough concentration of voriconazole.METHODS This study retrospectively analyzed 12 adult CPA patients who developed hepatotoxicity during the voriconazole treatment.In these patients,the oral dose was reduced to 3/4 or 1/2 of the standard dose(4 mg/kg,twice daily),and the lower limit of voriconazole trough concentration was maintained more than 0.5μg/m L.The trend of remission of liver toxicity after drug reduction in 12 patients was recorded.During the same period,25 patients who received standard doses served as the control group.Data from the two groups were collected and analyzed for different parameters such as demographic characteristics,underlying pulmonary disorders,laboratory tests,and therapeutic effect.The differences between the two groups were statistically compared.RESULTS Hepatotoxicity occurred in 12 patients within 28-65 d after oral voriconazole treatment.Hepatotoxicity was mainly manifested by the significantly increased level of gamma-glutamyltransferase and a slight increase of alanine aminotransferase and aspartate aminotransferase.The oral dose of voriconazole was reduced to approximately 3 mg/kg in seven patients and approximately 2 mg/kg in five patients.The average trough concentrations for the 12 patients before and after voriconazole oral dose reduction were 3.17±1.47μg/m L(1.5-6.0μg/m L)and 1.70±0.78μg/m L(0.6-3.3μg/m L),respectively(P=0.02).After lowering the trough concentrations,the hepatotoxicity was alleviated in all the patients.However,gamma-glutamyltransferase levels declined slowly.After 4 mo of treatment,7 of the 12 patients were successfully treated in the lo

关 键 词：VORICONAZOLE HEPATOTOXICITY Chronic pulmonary aspergillosis CYP2C19 genotypes Reduction Trough concentration 

分 类 号：R519.8[医药卫生—内科学]