Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy and haemopoietic stem cell transplant recipients, 2021

Antifungal agents can have complex dosing and the potential for drug interaction, both of which can lead to subtherapeutic antifungal drug concentrations and poorer clinical outcomes for patients with haematological malignancy and haemopoietic stem cell transplant recipients. Antifungal agents can a...

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Veröffentlicht in:Internal medicine journal Jg. 51; H. S7; S. 37 - 66
Hauptverfasser: Chau, Maggie M., Daveson, Kathryn, Alffenaar, Jan‐Willem C., Gwee, Amanda, Ho, Su Ann, Marriott, Deborah J. E., Trubiano, Jason A., Zhao, Jessie, Roberts, Jason A.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Melbourne John Wiley & Sons Australia, Ltd 01.11.2021
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Schlagworte:
Antifungal Agents
antifungal therapy
Cytochrome P450
Dosage
Drug delivery
Drug dosages
Drug interaction
Drug Interactions
Drug metabolism
Drug Monitoring
Gene polymorphism
Hematologic Neoplasms - drug therapy
Hematology
Hematopoietic Stem Cell Transplantation
Humans
Malignancy
Patients
pharmacogenomics
Stem cell transplantation
therapeutic drug monitoring
Toxicity
toxicity
antifungal therapy
pharmacogenomics
drug interaction
therapeutic drug monitoring
ISSN:1444-0903, 1445-5994, 1445-5994
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Zusammenfassung:Antifungal agents can have complex dosing and the potential for drug interaction, both of which can lead to subtherapeutic antifungal drug concentrations and poorer clinical outcomes for patients with haematological malignancy and haemopoietic stem cell transplant recipients. Antifungal agents can also be associated with significant toxicities when drug concentrations are too high. Suboptimal dosing can be minimised by clinical assessment, laboratory monitoring, avoidance of interacting drugs, and dose modification. Therapeutic drug monitoring (TDM) plays an increasingly important role in antifungal therapy, particularly for antifungal agents that have an established exposure‐response relationship with either a narrow therapeutic window, large dose‐exposure variability, cytochrome P450 gene polymorphism affecting drug metabolism, the presence of antifungal drug interactions or unexpected toxicity, and/or concerns for non‐compliance or inadequate absorption of oral antifungals. These guidelines provide recommendations on antifungal drug monitoring and TDM‐guided dosing adjustment for selected antifungal agents, and include suggested resources for identifying and analysing antifungal drug interactions. Recommended competencies for optimal interpretation of antifungal TDM and dose recommendations are also provided.
Bibliographie:Australasian Antifungal Guidelines Steering Committee: Christina C Chang, Christopher C Blyth, Sharon C‐A Chen, Anna Khanina, C. Orla Morrissey, Jason A. Roberts, Karin A Thursky, Leon Worth, Monica A Slavin.
Conflict of interest: The following working group members are consultants or advisory committee members or receive honoraria, fees for service, or travel assistance from; or have research or other associations with the organisations listed: J. A. Roberts – Pfizer, Sandoz, Wolters Kluwer, Merck, Sharpe & Dohme, QPEX, Discuva Ltd., Accelerate Diagnostics, Bayer, Biomerieux, Cipla, The Medicines Company, Cardeas Pharma; A. Gwee – Merck, Sharpe & Dohme; J. A. Trubiano – Merck, Sharpe & Dohme.
Funding: J. A. Roberts would like to acknowledge funding from the Australian National Health and Medical Research Council for a Centre of Research Excellence (APP1099452) and a Practitioner Fellowship (APP1117065).
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ISSN:1444-0903
1445-5994
1445-5994
DOI:10.1111/imj.15587