ArticleAntimicrobial agents and chemotherapy2012
Prospective, observational study of voriconazole therapeutic drug monitoring among lung transplant recipients receiving prophylaxis: factors impacting levels of and associations between serum troughs, efficacy, and toxicity.
Article in Antimicrobial agents and chemotherapy, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
50 citing papers in PubMed, 5 syntheses or guidelines pooled it, 127 citations in OpenAlex.
- Antifungal prophylaxis in lung transplant recipients: A systematic review and meta-analysis.Transplant infectious disease : an official journal of the Transplantation Society · 2020Pooled it
- Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review.BMJ open · 2020Pooled it
- Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Guideline
- Trough concentration of voriconazole and its relationship with efficacy and safety: a systematic review and meta-analysis.The Journal of antimicrobial chemotherapy · 2016Pooled it
- Brazilian guidelines for the diagnosis and treatment of candidemia and invasive candidiasis in adults and children.The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious DiseasesGuideline
- Pharmacokinetics and safety of voriconazole intravenous-to-oral switch regimens in immunocompromised Japanese pediatric patients.Antimicrobial agents and chemotherapy · 2015Trial
- Achieving target voriconazole concentrations more accurately in children and adolescents.Antimicrobial agents and chemotherapy · 2015Trial
- Invasive aspergillosis in lung and heart transplant recipients.JHLT open · 2026Article
- Beyond Algorithms: Machine Learning and Clinical Determinants of Voriconazole Plasma Levels in Therapeutic Drug Monitoring.European journal of drug metabolism and pharmacokinetics · 2026Article
- Establishment and validation of a predictive nomogram for voriconazole-associated liver injury in lung transplant patients.International journal of clinical pharmacy · 2025Observational
- Therapeutic drug monitoring and safety of voriconazole in patients with liver dysfunction.Antimicrobial agents and chemotherapy · 2024Article
- Factors influencing voriconazole plasma level in intensive care patients.JAC-antimicrobial resistance · 2024Article
- The Effect of Rifapentine and Rifampicin on Serum Voriconazole Levels Persist for 5 Days and 7 Days or More After Discontinuation in Tuberculosis Patients with Chronic Pulmonary Aspergillosis.Infection and drug resistance · 2024Article
- Invasive Aspergillosis among Lung Transplant Recipients during Time Periods with Universal and Targeted Antifungal Prophylaxis-A Nationwide Cohort Study.Journal of fungi (Basel, Switzerland) · 2023Article
- Adverse Events Associated with Universal versus Targeted Antifungal Prophylaxis among Lung Transplant Recipients-A Nationwide Cohort Study 2010-2019.Microorganisms · 2022Article
- Therapeutic drug monitoring and safety evaluation of voriconazole in the treatment of pulmonary fungal diseases.Therapeutic advances in drug safety · 2022Article
- Isavuconazole Is as Effective as and Better Tolerated Than Voriconazole for Antifungal Prophylaxis in Lung Transplant Recipients.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Favorable Effects of Voriconazole Trough Concentrations Exceeding 1 μg/mL on Treatment Success and All-Cause Mortality: A Systematic Review and Meta-Analysis.Journal of fungi (Basel, Switzerland) · 2021Article
- Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant.Journal of fungi (Basel, Switzerland) · 2021Review
- Review of Pharmacologic Considerations in the Use of Azole Antifungals in Lung Transplant Recipients.Journal of fungi (Basel, Switzerland) · 2021Review
Corrections and comments
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Voriconazole prophylaxis is common following lung transplantation, but the value of therapeutic drug monitoring is unknown. A prospective, observational study of lung transplant recipients (n = 93) receiving voriconazole prophylaxis was performed. Serum voriconazole troughs (n = 331) were measured by high-pressure liquid chromatography. The median initial and subsequent troughs were 1.91 and 1.46 μg/ml, respectively. The age of the patient directly correlated with initial troughs (P = 0.005). Patients that were ≥ 60 years old and cystic fibrosis patients were significantly more likely to have higher and lower initial troughs, respectively. In 95% (88/93) of patients, ≥ 2 troughs were measured. In 28% (25/88) and 32% (28/88) of these patients, all troughs were ≤ 1.5 μg/ml or >1.5 μg/ml, respectively. Ten percent (10/93) and 27% (25/93) of the patients developed invasive fungal infection (tracheobronchitis) and fungal colonization, respectively. The median troughs at the times of positive and negative fungal cultures were 0.92 and 1.72 μg/ml (P = 0.07). Invasive fungal infections or colonization were more likely with troughs of ≤ 1.5 μg/ml (P = 0.01) and among patients with no trough of >1.5 μg/ml (P = 0.007). Other cutoff troughs correlated less strongly with microbiologic outcomes. Troughs correlated directly with aspartate transferase levels (P = 0.003), but not with other liver enzymes. Voriconazole was discontinued due to suspected toxicity in 27% (25/93) of the patients. The troughs did not differ at the times of suspected drug-induced hepatotoxicity, central nervous system (CNS) toxicity, or nausea/vomiting and in the absence of toxicity. Voriconazole prophylaxis was most effective at troughs of >1.5 μg/ml. A cutoff for toxicity was not identified, but troughs of >4 μg/ml were rare. The data support a target range of >1.5 to 4 μg/ml.
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