ArticleEuropean journal of clinical pharmacology2026
Trough concentration of voriconazole and its association with central nervous system toxicity in patients with hematologic malignancies: a retrospective cohort study.
Article in European journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeVoriconazole (VRC), a broad-spectrum antifungal agent, is commonly used for the treatment and prophylaxis of invasive fungal disease (IFD) in patients with hematologic malignancies following chemotherapy. However, its clinical application is often limited by central nervous system (CNS) toxicity. CNS toxicity was defined using the National Cancer Institute criteria, such as hallucinations and anxiety. The aim of this study was to identify risk factors associated with VRC-induced CNS toxicity and to determine the plasma trough concentration (Cmin) threshold.
methodsThis retrospective cohort study analyzed clinical data from 126 patients with hematologic malignancies who received VRC after chemotherapy and underwent therapeutic drug monitoring (TDM).
resultsThe 126 patients, 30 (23.8%) developed CNS toxicity related to VRC. The median time to onset of CNS toxicity was 6 days following VRC initiation. VRC Cmin levels were significantly associated with an increased risk of CNS toxicity (odds ratio: 2.08; 95% confidence interval [CI]: 1.56–2.78, p < 0.001 per 1 mg/L increment on multivariate analysis). Receiver operating characteristic curve analysis identified a Cmin threshold of 4.79 mg/L for predicting CNS toxicity, with an area under the curve of 0.89 (95% CI: 0.82–0.97; P < 0.001) and sensitivities and specificities of 0.87 and 0.85, respectively.
conclusionTherefore, routine TDM is recommended for patients with hematologic malignancies receiving VRC to minimize the risk of CNS toxicity.
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