ArticleJournal of fungi (Basel, Switzerland)2021
Favorable Effects of Voriconazole Trough Concentrations Exceeding 1 μg/mL on Treatment Success and All-Cause Mortality: A Systematic Review and Meta-Analysis.
Article in Journal of fungi (Basel, Switzerland), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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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
16 citing papers in PubMed, 32 citations in OpenAlex.
- Microdialysis of Voriconazole and its N-Oxide Metabolite: Amalgamating Knowledge of Distribution and Metabolism Processes in Humans.Pharmaceutical research · 2022Trial
- Optimization strategies for voriconazole dosing in pediatric populations: integrating therapeutic indications and age-stratified pharmacokinetics.Antimicrobial agents and chemotherapy · 2026Article
- Current Evidence on Voriconazole Exposure and Individualized Therapy for Aspergillosis.Infection and drug resistance · 2026Review
- Voriconazole-induced periostitis in a child with finger pain and nodules: case report and literature review.BMC musculoskeletal disorders · 2025Review
- The Predictive Value of Initial Trough Concentration of Voriconazole and Procalcitonin in Hepatotoxic Adverse Events.Drug design, development and therapy · 2025Article
- Study on the correlation between plasma concentration of voriconazole and clinical efficacy and safety in elderly patients.Frontiers in pharmacology · 2025Article
- The Role of Plasma Trough Concentration of Voriconazole and Voriconazole N-Oxide in Its Hepatotoxicity in Adult Patients.Drug design, development and therapy · 2024Article
- Factors affecting voriconazole concentration to dose ratio changes according to route of administration.European journal of hospital pharmacy : science and practice · 2023Article
- Development of a New Method for Simultaneous Quantitation of Plasma Concentrations of Voriconazole and VoriconazoleYonago acta medica · 2023Article
- A Critical Review on the Dosing and Safety of Antifungals Used in Exotic Avian and Reptile Species.Journal of fungi (Basel, Switzerland) · 2023Review
- The Development and Validation of a Predictive Model for Voriconazole-Related Liver Injury in Hospitalized Patients in China.Journal of clinical medicine · 2023Article
- Antifungal Drug Resistance: An Emergent Health Threat.Biomedicines · 2023Review
- Enhancing voriconazole therapy in liver dysfunction: exploring administration schemes and predictive factors for trough concentration and efficacy.Frontiers in pharmacology · 2023Article
- The Diagnosis and Treatment of Fungal Endophthalmitis: An Update.Diagnostics (Basel, Switzerland) · 2022Review
- Amikacin Therapy in Japanese Pediatric Patients: Narrative Review.International journal of environmental research and public health · 2022Review
- A Strategy for Hospital Pharmacists to Control Antimicrobial Resistance (AMR) in Japan.Antibiotics (Basel, Switzerland) · 2021Review
Corrections and comments
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Authors and funding
9 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This systematic review and meta-analysis examined the optimal trough concentration of voriconazole for adult patients with invasive fungal infections. We used stepwise cutoffs of 0.5-2.0 μg/mL for efficacy and 3.0-6.0 μg/mL for safety. Studies were included if they reported the rates of all-cause mortality and/or treatment success, hepatotoxicity, and nephrotoxicity according to the trough concentration. Twenty-five studies involving 2554 patients were included. The probability of mortality was significantly decreased using a cutoff of ≥1.0 μg/mL (odds ratio (OR) = 0.34, 95% confidence interval (CI) = 0.15-0.80). Cutoffs of 0.5 (OR = 3.48, 95% CI = 1.45-8.34) and 1.0 μg/mL (OR = 3.35, 95% CI = 1.52-7.38) also increased the treatment success rate. Concerning safety, significantly higher risks of hepatotoxicity and neurotoxicity were demonstrated at higher concentrations for all cutoffs, and the highest ORs were recorded at 4.0 μg/mL (OR = 7.39, 95% CI = 3.81-14.36; OR = 5.76, 95% CI 3.14-10.57, respectively). Although further high-quality trials are needed, our findings suggest that the proper trough concentration for increasing clinical success while minimizing toxicity is 1.0-4.0 μg/mL for adult patients receiving voriconazole therapy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.