ArticleBMC infectious diseases2013
Voriconazole therapeutic drug monitoring: retrospective cohort study of the relationship to clinical outcomes and adverse events.
Article in BMC infectious diseases, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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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
35 citing papers in PubMed, 1 synthesis or guideline pooled it, 73 citations in OpenAlex.
- Trough concentration of voriconazole and its relationship with efficacy and safety: a systematic review and meta-analysis.The Journal of antimicrobial chemotherapy · 2016Pooled it
- Safety, Efficacy, and Exposure-Response of Voriconazole in Pediatric Patients With Invasive Aspergillosis, Invasive Candidiasis or Esophageal Candidiasis.The Pediatric infectious disease journal · 2017Trial
- Pharmacokinetics and safety of voriconazole intravenous-to-oral switch regimens in immunocompromised Japanese pediatric patients.Antimicrobial agents and chemotherapy · 2015Trial
- Supratherapeutic drug concentration triggers: A novel data-driven approach to assess their value for medication safety surveillance in intensive care.British journal of clinical pharmacology · 2026Article
- Voriconazole-Induced Agranulocytosis in a Cirrhotic Patient with Influenza-Associated Pulmonary Aspergillosis: A Case Report.Infection and drug resistance · 2026Article
- Establishment and validation of a predictive nomogram for voriconazole-associated liver injury in lung transplant patients.International journal of clinical pharmacy · 2025Observational
- The Predictive Value of Initial Trough Concentration of Voriconazole and Procalcitonin in Hepatotoxic Adverse Events.Drug design, development and therapy · 2025Article
- Clinical pharmacist-led antifungal drug utilization reviews in cancer care hospital: a prospective audit and feedback.JAC-antimicrobial resistance · 2024Article
- Factors influencing voriconazole plasma level in intensive care patients.JAC-antimicrobial resistance · 2024Article
- Missed Opportunities for Antifungal Stewardship during the COVID-19 Era.Antibiotics (Basel, Switzerland) · 2023Article
- Nanotechnology-Based Approaches for Voriconazole Delivery Applied to Invasive Fungal Infections.Pharmaceutics · 2023Review
- Voriconazole-Induced Hepatotoxicity in a Patient with Pulmonary Aspergillosis: A Case Report.Infection and drug resistance · 2023Article
- Optimizing antifungal prophylaxis in allogeneic stem cell transplantation: A cohort study of two different approaches.Transplant infectious disease : an official journal of the Transplantation Society · 2022Observational
- Central Nervous System Toxicity of Voriconazole: Risk Factors and Threshold - A Retrospective Cohort Study.Infection and drug resistance · 2022Article
- Therapeutic drug monitoring and safety evaluation of voriconazole in the treatment of pulmonary fungal diseases.Therapeutic advances in drug safety · 2022Article
- Voriconazole Use in Children: Therapeutic Drug Monitoring and Control of Inflammation as Key Points for Optimal Treatment.Journal of fungi (Basel, Switzerland) · 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
- Voriconazole Induced Hallucinations and Visual Disturbances in a Female Child: A Case Report and Literature Review.Frontiers in pediatrics · 2021Article
- Association of Voriconazole Trough Plasma Concentration with Efficacy and Incidence of Hepatotoxicity in Iranian Patients with Hematological Malignancies.Iranian journal of pharmaceutical research : IJPR · 2021Article
- How I perform hematopoietic stem cell transplantation on patients with a history of invasive fungal disease.Blood · 2020Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVoriconazole is approved for treatment of invasive aspergillosis and other invasive fungal infections, but the role for therapeutic drug monitoring (TDM) is not clear.
methodsWe performed a retrospective cohort study of patients at the University of Washington Medical Center and Fred Hutchinson Cancer Research Center from 2007-2009. We compared the effect of therapeutic levels on clinical outcomes and evaluated the relationship between drug levels and adverse events.
resultsA total of 108 patients had voriconazole TDM performed, of whom 84 (77.8%) had a hematologic malignancy and 47 (43.5%) had undergone hematopoietic stem cell transplantation. The primary reasons for treatment were presumed pulmonary aspergillosis (n = 83, 76.8%), other invasive mould infections (n = 13, 12.0%) and candidiasis (n = 9, 8.3%). There was a high degree of variability in voriconazole drug levels among patients (r2 = 0.01; range, <0.10 - 20 mg/L). Of the 46 patients with proven or probable invasive fungal disease, 25 (54.3%) achieved partial or complete response to therapy. There was no significant relationship between therapeutic drug levels and achievement of complete or partial response at 12 weeks (OR 0.29, 95% CI: 0.05-1.34) or radiologic response (OR 1.46, 95% CI: 0.32-7.83). Overall, 45 (41.7%) patients experienced adverse events. Voriconazole levels > 5.5 mg/L were not associated with increased incidence of encephalopathy (OR 3.08, 95% CI 0.79-11.0) or hepatotoxicity (OR 2.45, 95% CI 0.49-10.1).
conclusionsVoriconazole therapeutic drug levels were not associated with improvement in clinical outcomes among patients with proven or probable invasive fungal disease. We also did not find an association between supratherapeutic drug levels and hepatoxicity or encephalopathy. It is possible that the utility of voriconazole therapeutic drug monitoring to improve clinical efficacy or decrease adverse events may be limited to a subset of high-risk patients.
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