Voriconazole Antifungal Prophylaxis in Children With Malignancies: A Nationwide Study

Pana, Zoi Dorothea; Kourti, Maria; Vikelouda, Katerina; Vlahou, Antonia; Katzilakis, Nikolaos; Papageorgiou, Maria; Doganis, Dimitrios; Petrikkos, Loizos; Paisiou, Anna; Koliouskas, Dimitrios; Kattamis, Antonios; Stiakaki, Eftichia; Chatzistilianou, M; Vasilatou-Kosmidis, Helen; Polychronopoulou, Sophia; Grafakos, Stelios; Roilides, Emmanuel

doi:10.1097/mph.0000000000000926

Cited by 16 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The available paediatric data on voriconazole safety are heterogeneous, as the criteria for classifying AEs and attributing them to the drug vary widely between studies. However, the percentage of AEs we detected is similar to the values reported in other studies using the same AE classification [29,[44][45][46]72]. We mention that our recording of up to four liver function parameters, including changes with no clinical impact, may have led to an overestimation of hepatic AEs in our study.…”

Section: Discussionsupporting

confidence: 89%

Voriconazole Use in Children: Therapeutic Drug Monitoring and Control of Inflammation as Key Points for Optimal Treatment

Valle-T-Figueras

Miró

Carabante

et al. 2021

JoF

View full text Add to dashboard Cite

Voriconazole plasma concentrations (PC) are highly variable, particularly in children. Dose recommendations in 2–12-year-old patients changed in 2012. Little data on therapeutic drug monitoring (TDM) after these new recommendations are available. We aimed to evaluate voriconazole monitoring in children with invasive fungal infection (IFI) after implementation of new dosages and its relationship with safety and effectiveness. A prospective, observational study, including children aged 2–12 years, was conducted. TDM was performed weekly and doses were changed according to an in-house protocol. Effectiveness, adverse events, and factors influencing PC were analysed. A total of 229 PC from 28 IFI episodes were obtained. New dosing led to a higher rate of adequate PC compared to previous studies; still, 35.8% were outside the therapeutic range. In patients aged <8 years, doses to achieve therapeutic levels were higher than recommended. Severe hypoalbuminemia and markedly elevated C-reactive protein were related to inadequate PC. Therapeutic PC were associated with drug effectiveness and safety. Higher doses in younger patients and a dose adjustment protocol based on TDM should be considered. Voriconazole PC variability has decreased with current updated recommendations, but it remains high and is influenced by inflammatory status. Additional efforts to control inflammation in children with IFI should be encouraged.

show abstract

Section: Discussionsupporting

confidence: 89%

Voriconazole Use in Children: Therapeutic Drug Monitoring and Control of Inflammation as Key Points for Optimal Treatment

Valle-T-Figueras

Miró

Carabante

et al. 2021

JoF

View full text Add to dashboard Cite

show abstract

“…Since 2014, observational studies of children with cancer or following HSCT have reported a breakthrough proven/probable IFD rate between 0 and 12% with voriconazole. [131][132][133][134] In the study reporting a 12% breakthrough rate, patients received voriconazole doses of between 5 and 10 mg/kg/day, 134 which is below the currently recommended dose (Table 7). 135…”

Section: Voriconazolementioning

confidence: 99%

Consensus guidelines for antifungal prophylaxis in haematological malignancy and haemopoietic stem cell transplantation, 2021

Teh

Yeoh

Haeusler

et al. 2021

Internal Medicine Journal

View full text Add to dashboard Cite

Antifungal prophylaxis can reduce morbidity and mortality from invasive fungal disease (IFD). However, its use needs to be optimised and appropriately targeted to patients at highest risk to derive the most benefit. In addition to established risks for IFD, considerable recent progress in the treatment of malignancies has resulted in the development of new 'at-risk' groups. The changing epidemiology of IFD and emergence of drug resistance continue to impact choice of prophylaxis, highlighting the importance of active surveillance and knowledge of local epidemiology. These guidelines aim to highlight emerging risk groups and review the evidence and limitations around new formulations of established agents and new antifungal drugs. It provides recommendations around use and choice of antifungal prophylaxis, discusses the potential impact of the changing epidemiology of IFD and emergence of drug resistance, and future directions for risk stratification to assist optimal management of highly vulnerable patients.

show abstract

“…In pediatric patients, voriconazole exposure displays substantial variability [46] and, consequently, TDM is required to maintain the plasma concentration of 1–5 mg/L [8,47,48]. In the “Voriproph” study—the largest cohort study of voriconazole chemoprophylaxis in children—the use of this agent has been well tolerated [49]. An age of <2 years is a contraindication to the use of voriconazole [8].…”

Section: Preventionmentioning

confidence: 99%

Invasive Aspergillosis in Pediatric Leukemia Patients: Prevention and Treatment

Papachristou

Iosifidis

Roilides

2019

JoF

Self Cite

View full text Add to dashboard Cite

The purpose of this article is to review and update the strategies for prevention and treatment of invasive aspergillosis (IA) in pediatric patients with leukemia and in patients with hematopoietic stem cell transplantation. The major risk factors associated with IA will be described since their recognition constitutes the first step of prevention. The latter is further analyzed into chemoprophylaxis and non-pharmacologic approaches. Triazoles are the mainstay of anti-fungal prophylaxis while the other measures revolve around reducing exposure to mold spores. Three levels of treatment have been identified: (a) empiric, (b) pre-emptive, and (c) targeted treatment. Empiric is initiated in febrile neutropenic patients and uses mainly caspofungin and liposomal amphotericin B (LAMB). Pre-emptive is a diagnostic driven approach attempting to reduce unnecessary use of anti-fungals. Treatment targeted at proven or probable IA is age-dependent, with voriconazole and LAMB being the cornerstones in >2yrs and <2yrs age groups, respectively.

show abstract

Voriconazole Antifungal Prophylaxis in Children With Malignancies: A Nationwide Study

Abstract: VRC prophylaxis in pediatric hematology/oncology patients appears to be well tolerated.

Cited by 16 publications

References 20 publications

Voriconazole Use in Children: Therapeutic Drug Monitoring and Control of Inflammation as Key Points for Optimal Treatment

Voriconazole Use in Children: Therapeutic Drug Monitoring and Control of Inflammation as Key Points for Optimal Treatment

Consensus guidelines for antifungal prophylaxis in haematological malignancy and haemopoietic stem cell transplantation, 2021

Invasive Aspergillosis in Pediatric Leukemia Patients: Prevention and Treatment

Contact Info

Product

Resources

About