1632. Voriconazole therapeutic drug monitoring among lung transplant recipients receiving targeted therapy for invasive aspergillosis
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Treatment
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDWeek_Vori.pdf (521.7 kB)
  • Background: Voriconazole is the recommended treatment for invasive aspergillosis (IA) in lung transplant recipients (LTR). The use of voriconazole therapeutic drug monitoring (TDM) is increasingly recommended but its use remains controversial. We conducted a study to explore the association between voriconazole serum concentration and clinical outcome of LTR receiving targeted therapy for IA.

    Methods: We conducted a retrospective study of all lung transplant recipients receiving IA voriconazole targeted mono-therapy who underwent serum TDM between January 2013 and December 2015 at Notre-Dame Hospital, CHUM, Montreal, Canada. Chart review was performed to collect demographic, clinical and laboratory data. Clinical outcome and mortality were assessed at 12 weeks after initation of therapy. Classification and regression tree (CART) analysis was used to find the most predictive voriconazole level thresholds for successful outcome.

    Results: Among the 111 LTR during the study period, 11 received voriconazole monotherapy for targeted therapy and underwent TDM during therapy. All 11 patients had pulmonary involvement, without dissemination. At 12 weeks of therapy, 6 patients achieved successful outcome while 5 patients did not. The median TDM value among patients who achieved successful outcome vs patients who failed therapy were 0.9 (0.3-7.3) µg/mL and 0.6 (0.05-4.9) µg/mL respectively. Two separate CART analyses were performed; one was based on the median voriconazole TDM concentration, the other was based on minimal voriconazole TDM concentration for each patient. Successful outcome were more likely attained among patients with median TDM concentration > 0.645 µg/mL (P= 0.06) or minimal TDM concentration > 0.415 µg/mL (P=0.02). None of the patient died during the study period.

    Conclusion: Our study demonstrates that voriconazole targeted therapy among lung transplant recipients with invasive aspergillosis is associated with a better treatment response when median TDM concentration are greater than 0.645 µg/mL or when minimal TDM concentration are greater than 0.415 µg/mL.

    Guillaume Butler-Laporte, MDCM, Department of Medicine, McGill University, Montréal, QC, Canada, Charles Poirier, MD, Respirology, University of Montreal Health Center, Montreal, QC, Canada, Pasquale Ferraro, MD, Thoracic Surgery, University of Montreal Health Center, Montreal, QC, Canada, Marie-Claude Langevin, PharmD, Department of Pharmacy, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada, Claude Lemieux, MD, Department of Medical Microbiology and Infectious Diseases, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada, Yves Theoret, MD, Department of Pharmacology, Ste-Justine Hospital, Montréal, QC, Canada and Me-Linh Luong, MD, Department of Medical Microbiology and Infectious Diseases, University of Montreal Health Center, Montreal, QC, Canada

    Disclosures:

    G. Butler-Laporte, None

    C. Poirier, None

    P. Ferraro, None

    M. C. Langevin, None

    C. Lemieux, None

    Y. Theoret, None

    M. L. Luong, None

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