SynthesisThe Journal of antimicrobial chemotherapy2016
Trough concentration of voriconazole and its relationship with efficacy and safety: a systematic review and meta-analysis.
Synthesis in The Journal of antimicrobial chemotherapy, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 104 papers, 9 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.
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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
104 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- Pooled it
- Pooled it
- A Systematic Review of Population Pharmacokinetics, Safety, and Factors Influencing Trough Concentrations of Voriconazole in Asian Patients with Liver Dysfunction.Drug design, development and therapy · 2025Pooled it
- Associated factors with voriconazole plasma concentration: a systematic review and meta-analysis.Frontiers in pharmacology · 2024Pooled it
- Clinical research advances of isavuconazole in the treatment of invasive fungal diseases.Frontiers in cellular and infection microbiology · 2022Pooled it
- Too Much of a Good Thing: Defining Antimicrobial Therapeutic Targets to Minimize Toxicity.Clinical pharmacology and therapeutics · 2021Pooled it
- Individualized Medication of Voriconazole: A Practice Guideline of the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society.Therapeutic drug monitoring · 2018Guideline
- Utility of posaconazole therapeutic drug monitoring and assessment of plasma concentration threshold for effective prophylaxis of invasive fungal infections: a meta-analysis with trial sequential analysis.BMC infectious diseases · 2018Pooled it
- Effect of cytochrome P450 2C19 polymorphisms on the clinical outcomes of voriconazole: a systematic review and meta-analysis.European journal of clinical pharmacology · 2016Pooled it
- Pharmacokinetic and Exposure Response Analysis of the Double-Blind Randomized Study of Posaconazole and Voriconazole for Treatment of Invasive Aspergillosis.Clinical drug investigation · 2023Trial
- Variability and exposure-response relationships of isavuconazole plasma concentrations in the Phase 3 SECURE trial of patients with invasive mould diseases.The Journal of antimicrobial chemotherapy · 2019Trial
- Assessing the Influence of CYP3A4 Inhibitors on Voriconazole Exposure across CYP2C19 Genotypes: A Physiologically Based Pharmacokinetic Model Analysis.Clinical pharmacokinetics · 2026Article
- External evaluation of published voriconazole population pharmacokinetic models in adult patients undergoing extracorporeal membrane oxygenation.European journal of clinical pharmacology · 2026Article
- Asthma and Allergic Bronchopulmonary Aspergillosis: Understanding, Insights, and State-of-the-Art.Journal of inflammation research · 2026Review
- Voriconazole-associated adverse drug reactions in Chinese patients: incidence, clinical features and the predictive value of ALBI score for hepatotoxicity.Frontiers in pharmacology · 2026Article
- An Interpretable PK-Informed Hybrid Model for Voriconazole Exposure Prediction: Roles of CYP2C19 Genotype and Inflammation.Drug design, development and therapy · 2026Article
- Current Evidence on Voriconazole Exposure and Individualized Therapy for Aspergillosis.Infection and drug resistance · 2026Review
- Pharmacist-Led Full-Course Pharmaceutical Care Model in Allergic Bronchopulmonary Aspergillosis: A Case Report-Based Approach to Optimizing Multidisciplinary Management.Infection and drug resistance · 2026Article
- The role of circulating metallothionein 1 in voriconazole-associated hepatotoxicity.Naunyn-Schmiedeberg's archives of pharmacology · 2026Article
- Repeated voriconazole therapeutic drug monitoring in hospitalised patients: a real-world cohort study of out-of-range exposure and concentration response to dose adjustment.Frontiers in pharmacology · 2026Article
44 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe optimum trough concentration of voriconazole for clinical response and safety is controversial. The objective of this review was to determine the optimum trough concentration of voriconazole and evaluate its relationship with efficacy and safety.
methodsMEDLINE, EMBASE, ClinicalTrials.gov, the Cochrane Library and three Chinese literature databases were searched. Observational studies that compared clinical outcomes below and above the trough concentration cut-off value were included. We set the trough concentration cut-off value for efficacy as 0.5, 1.0, 1.5, 2.0 and 3.0 mg/L and for safety as 3.0, 4.0, 5.0, 5.5 and 6.0 mg/L. The efficacy outcomes were invasive fungal infection-related mortality, all-cause mortality, rate of successful treatment and rate of prophylaxis failure. The safety outcomes included incidents of hepatotoxicity, neurotoxicity and visual disorders.
resultsA total of 21 studies involving 1158 patients were included. Compared with voriconazole trough concentrations of >0.5 mg/L, levels of <0.5 mg/L significantly decreased the rate of treatment success (risk ratio = 0.46, 95% CI 0.29-0.74). The incidence of hepatotoxicity was significantly increased with trough concentrations >3.0, >4.0, >5.5 and >6.0 mg/L. The incidence of neurotoxicity was significantly increased with trough concentrations >4.0 and >5.5 mg/L.
conclusionsA voriconazole level of 0.5 mg/L should be considered the lower threshold associated with efficacy. A trough concentration >3.0 mg/L is associated with increased hepatotoxicity, particularly for the Asian population, and >4.0 mg/L is associated with increased neurotoxicity.
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