동종조혈모세포이식 시 Cyclosporine과Voriconazole 또는 Fluconazole의 약물상호작용 비교
Drug Interaction between Cyclosporine and Voriconazole versus Cyclosporine and Fluconazole in Allogenic Hepatopoietic Stem Cell Transplantation
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Voriconazole and fluconazole are azole antifungal agents which the 2010 IDSA (Infectious Diseases Society of America) guideline of cancer neutropenic fever has recommended to use for fungal prophylaxis in hematopoietic stem cell transplantation. However, these agents are known to have an interaction with immunosuppressants such as calcineurin inhibitors, and to elevate the serum calcineurin inhibitors level. The goal of this study was to compare the drug interaction between voriconazole and cyclosporine with fluconazole and cyclosporine. Further,the we compared the renal function after the drug interactions. Fifty-nine patients were enrolled in this study from January 2007 to August 2011. Eleven patients received voriconazole, and forty-eight patients received fluconazole. In this study, there is a difference in cyclosporine dose among patients hence, we calculated the C/D ratio [(ng/mL)/(mg/kg)]. C/D ratio is represented as the serum trough level of cyclosporine when it is administered 1 mg/kg in patients. Peak day means the day that the C/D ratio reaches its peak value. The C/D ratio of the voriconazole group was 209.90±176.38 [(ng/mL)/(mg/kg)] and was higher than 129.36±38.20[(ng/mL)/(mg/kg)], the value of the fluconazole group. However, the peak day of the voriconazole group was 14.82±7.96 days and was slower than that of the fluconazole group. The alteration of the renal function test value was higher in the voriconazole group. Howerer, only BUN showed a significant difference between the two groups. There was no correlation between the C/D ratio and renal panel.
Abstract
Voriconazole and fluconazole are azole antifungal agents which the 2010 IDSA (Infectious Diseases Society of America) guideline of cancer neutropenic fever has recommended to use for fungal prophylaxis in hematopoietic stem cell transplantation. However, these agents are known to have an interaction with immunosuppressants such as calcineurin inhibitors, and to elevate the serum calcineurin inhibitors level. The goal of this study was to compare the drug interaction between voriconazole and cyclosporine with fluconazole and cyclosporine. Further,the we compared the renal function after the drug interactions. Fifty-nine patients were enrolled in this study from January 2007 to August 2011. Eleven patients received voriconazole, and forty-eight patients received fluconazole. In this study, there is a difference in cyclosporine dose among patients hence, we calculated the C/D ratio [(ng/mL)/(mg/kg)]. C/D ratio is represented as the serum trough level of cyclosporine when it is administered 1 mg/kg in patients. Peak day means the day that the C/D ratio reaches its peak value. The C/D ratio of the voriconazole group was 209.90±176.38 [(ng/mL)/(mg/kg)] and was higher than 129.36±38.20[(ng/mL)/(mg/kg)], the value of the fluconazole group. However, the peak day of the voriconazole group was 14.82±7.96 days and was slower than that of the fluconazole group. The alteration of the renal function test value was higher in the voriconazole group. Howerer, only BUN showed a significant difference between the two groups. There was no correlation between the C/D ratio and renal panel.
참고문헌 (22)
- Wingard J.R., "Advances in the management of infectious complications after bone marrow transplantation", Bone Marrow Transplant, 6(6), pp.371~ (1990)
- "2010 ISDA guideline , Clinical practice guideline for the use antimicrobial agent in neutropenic patient with cancer : 2010 update guideline", ~ (2010)
- Eyal Robenshtok, "Antifungal prophylaxis in Cancer patients after chemotherapy or hematopoietic stem cell transplantation: systemic review and meta analysis", J Clin Oncol, 25, pp.5471~5489 (2007)
- Livio Pagano, "Current therapeutic approaches to fungal infections in immunocompromised hematological patients", Blood Reviews, 24, pp.51~61 (2010)
- John R. Wingard, "Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogenic hematopoietic cell transplantation", Blood, 116, pp.5111~5118 (2010)
- "Micromedex- Voriconazole Drug information", ~
- "Micromedex- Fluconazole Drug information", ~
- T. Mori, "Drug interaction between voriconazole and calcineurin inhibitors in allogenic hematopoietic stem cell transplantation recipients", Bone Marrow Transplantation, 44, pp.371~374 (2009)
- H.L. Leather, "Drug interactions in the hematopoietic stem cell transplant (HSCT) recipient : what every transplanter needs to know", Bone Marrow Transplantation, 33, pp.137~152 (2004)
- Paul O. Gubbins, "Mould-active azoles: pharmacokinetics, drug interactions in neutropenic patients", Curr Opin Infect Dis, 20, pp.579~586
- Andreas H. Groll, "Pharmacokinetic interaction between voriconazole and cyclosporine A following allogenic bone marrow transplantation", Journal of Antimicrobial Chemotherapy, 53, pp.113~114 (2004)
- Hitoshi Kawazoe, "Change of the blood concentration of tacrolimus after the switch from fluconazole to voriconazole in patients receiving allogenic hematopoietic stem cell transplantation", Biol. Pharm. Bull, 29(12), pp.2528~2531 (2006)
- Ai Mihar, "Greater impact of oral fluconazole on drug interaction with intravenous calcineurin inhibitor as compared with intravenous fluconazole", Eur J Clin Pharmacol, 64, pp.89~91 (2008)
- S.M. Trifilio, "Tacrolimus use in adult allogeneic stem cell transplant recipient receiving voriconazole: preemptive dose modification and therapeutic drug monitoring", Bone Marrow Transplantation, 40, pp.451~456 (2007)
- "Micromedex- Cyclosporine Drug information", ~
- Steven Gabardi, "Factor influencing the magnitude and clinical significance of drug interaction between azole antifungal and select immunosuppressant", Pharmacotherapy, 27(4), pp.e3~e6 (2007)
- Alain J. Romero, "Effect of voriconazole on the pharmacokinetics of cyclosporine in renal transplant patient", Clinical pharmacology and Therapeutics, 71(4), pp.226~234 (2002)
- 김승은, "장기 이식 환자에서 voriconazole과 cyclosporine 또는 tacrolmus의 상호작용", 병원약사회지, 26(1), pp.35~42 (2009), 한국병원약사회
- S. Kimura, "Pharmacokinetics of CsA during the switch from continuous intravenous infusion to oral administration after allogeneic hematopoietic stem cell transplantation", Bone Marrow Transplantation, 45, pp.1088~1094 (2010)
- Schrauder A., "Pharmacokinetic monitoring of intravenous cyclosporine A in pediactric stem-cell transplant recipients", Pediatric Transplantation, 13, pp.444~450 (2009)
- Chirag R. Parikh, "Renal dysfunction in allogeneic hematopoietic cell transplantation", Kidney Int, 62(2), pp.566~ (2002)
- Sangeeta R., "Acute renal failure after myeloablative hematopoietic cell transplant: incidence and risk factors", Kidney Int, 67(1), pp.272~ (2005)