1. Lower blood levels of isavuconazole in critically ill patients compared with other populations: possible need for therapeutic drug monitoring.
- Author
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Mikulska, Malgorzata, Melchio, Monica, Signori, Alessio, Ullah, Nadir, Miletich, Franca, Sepulcri, Chiara, Limongelli, Alessandro, Giacobbe, Daniele Roberto, Balletto, Elisa, Russo, Chiara, Magnasco, Laura, Vena, Antonio, Grazia, Carmen Di, Raiola, Anna Maria, Portunato, Federica, Dentone, Chiara, Battaglini, Denise, Ball, Lorenzo, Robba, Chiara, and Angelucci, Emanuele
- Subjects
DRUG monitoring ,CRITICALLY ill ,EXTRACORPOREAL membrane oxygenation ,RENAL replacement therapy ,ASSISTED suicide - Abstract
Background Isavuconazole is first-line treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) is deemed not necessary, since most patients reached therapeutic levels (>1 mg/L) in large studies. Low levels were reported in some critically ill patients admitted to the ICU. The aim was to compare isavuconazole levels between critically ill and non-critically ill patients. Materials and methods Retrospective analysis of data from all patients treated with standard-dose isavuconazole between 1 January 2019 and 26 October 2022 was performed. The following data were collected: TDM results from the first 30 days of therapy; ward of admission; demographic and clinical characteristics; continuous renal replacement therapy; extracorporeal membrane oxygenation; and co-administered drugs. Results Seventy-two patients (median age 65 years) and 188 TDM measurements (mean number of samples per patient 2.6 ± 1.7) were included; 33 (45.8%) were ICU patients (3 also had haematological disorders); 39 (54.2%) were non-ICU patients, of whom 31 had haematological disorders. In all patients, the mean isavuconazole blood level was 3.33 ± 2.26 mg/L. Significantly lower levels were observed in the ICU versus the non-ICU population: mean 2.02 ± 1.22 versus 4.15 ± 2.31 mg/L (P < 0.001). Significantly higher rates of subtherapeutic levels were observed in ICU patients compared with the non-ICU population: all determinations <2 mg/L in 33.3% versus 7.7%, and all determinations <1 mg/L in 12.1% versus 0%, respectively. Predictors of lower isavuconazole levels were admission to the ICU, BMI > 25 kg/m
2 , bilirubin > 1.2 mg/dL and the absence of haematological disorder. Conclusions ICU patients had significantly lower isavuconazole blood levels compared to non-ICU population. The TDM of isavuconazole for efficacy should be performed in ICU. [ABSTRACT FROM AUTHOR]- Published
- 2024
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