The Study of Voriconazole Trough Level in the First Two Weeks After Administration in King Chulalongkorn Memorial Hospital.

NCT03260634 | Unknown

• 1 other identifier: 496-59
• Study Type: observational
• Target: 92
• Locations: 1 country
• Sites: 1

Brief Summary

Invasive fungal infections are a significant cause of morbidity and mortality in immunocompromised host such as prolong neutropenic patients , post transplantation patients, malignancies or advanced AIDS . The majority of these infections were caused by Aspergillus species, which the first line of treatment is antifungal agent, Voriconazole , a triazole antifungal drug which was approved by the Food and Drug Administration in May 2002 for the treatment of invasive aspergillosis and refractory infections of Scedosporium apiospermum and Fusarium spp. There are two forms of Voriconazole , oral and intravenous form. The recommendation dose is 6 mg/kg twice daily for two dosages, followed by 4 mg/kg twice daily in intravenous form or a loading dose of 400 mg twice daily for two doses is used (for individuals \>40 kg), followed by 200 mg twice daily, and in individuals \<40 kg the maintenance dose is 100 mg twice daily in oral form. Voriconazole has a narrow therapeutic window and nonlinear pharmacokinetic profile with wide inter-individual and intra-individual variability, such as age, race, genotypic variation, liver dysfunction, the presence of food and drug-drug interactions with CYP450 inhibitors. These large variations in pharmacokinetics may be associated with decreased efficacy or increased toxicity. Therefore , monitoring of serum trough concentrations is recommended in the following infections: invasive aspergillosis treatment , endophthalmitis; meningitis or osteoarticular infections due to Exserohilum rostratum. In Thai population , there are different genetic polymorphism from Caucasian ,resulting in a different response to the initial dose and there is limited resources in Thailand , mostly patients are unaccessible for Voriconazole level. Especially,in the period of starting drug, which is the critical period for patients ,most of them are post chemotherapy which may have gastrointestinal problems, mucositis , vomiting or diarrhea ,as well as receiving multiple concurrent medications. All of these affect drug absorption,drug level and efficacy of treatment. Thus, this study was designed to evaluated Voriconazole level in Thai patients in the first two week after administration. Primary question

• From the first collected of Voriconazole drug level , Are the invasive fungal infection patients in King Chulalongkorn Memorial Hospital achieved the drug level more than 60% ? Secondary question
• Which factor affecting Voriconazole through level in the first two weeks after administration? Research Design
• Observational Studies (Descriptive retrospective and prospective study) Research Methodology Target Population
• Patients received Voriconazole for treatment or prophylaxis invasive fungal infection Study population
• Patients in King Chulalongkorn Memorial hospital received Voriconazole for treatment or prophylaxis invasive fungal infection Sample size n= ZZ/2P(1-P) /dd
• n = sample size
• P =Incident rate
• From the pilot study of 15 Invasive fungal infection patients in King Chulalongkorn memorial hospital from February to September 2015 , 60% ( 9 of 15 patients) of the first collected of Voriconazole trough level achieved the therapeutic level. replaced P = 0.6
• Z = 95% confident interval = 1.96
• d = acceptable error = 0.10 n = (1.96) (1.96) (0.60)(1-0.60) / (0.10)(0.10) n =92 , sample size = 92 Study processing and data collection Data collection
• Collected data of patients received Voriconazole in first two weeks of treatment or prophylaxis invasive fungal infection in King Chulalongkorn Memorial hospital in 2015-2017 from outpatient records , inpatient records and computer database in King Chulalongkorn Memorial hospital. This data included
• Baseline characteristics : sex, age ,weight ,BMI ,co-morbid ,personal history of smoking or alcohol drinking
• Basic laboratory investigation : complete blood count , Creatinin , liver function test , albumin level
• Gastrointestinal problems
• Indication of Voriconazole treatment
• Data of invasive fungal infection :
• Data of Voriconazole usage : Loading dose, Maintenance dose, Trough level , Data of drug adjustment, Concurrent medication used, Side effect
• All data was summarized and recorded in case report forms. Data Analysis and Statistics The data was analysed by computer using SPSS17 program This study used descriptive statistics ,describing general information, age, results, laboratory results and side effects of the drug in mean ,percentage or standard deviation. And used the chi-square test for analysis of the proportion of patients with serum drug levels within the therapeutic range. This study used a confidence level of 95%, p-value less than 0.05 was statistically significant.

Conditions

Voriconazole; Fungal Infection

Keywords

voriconazole; therapeutic drug monitoring

Outcome Measures

Primary Outcomes (1)

• Percentage of patients achieved therapeutic level of voriconazole in the first two weeks after administration

  2015-2017

Secondary Outcomes (1)

• Factors have significant impact to voriconazole through level .

  2015-2017

Study Arms (1)

Voriconazole

Patient was received voriconazole according to individual indication. The starting dose is 6 mg/kg iv twice daily for two dosages, followed by 4 mg/kg iv twice daily in intravenous form or a loading dose of 400 mg twice daily for two doses is used (for individuals \>40 kg), followed by 200 mg twice daily, and in individuals \<40 kg the maintenance dose is 100 mg twice daily in oral form. The dosage was adjusted by drug level and toxicity. The duration of drug used was depended on indication of treatment.

Drug: Voriconazole

Interventions

Voriconazole DRUG

Voriconazole

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Thai patient in King Chulalongkorn Memorial Hospital ,Bangkok , Thailand, age between 18 and 80 year olds ,receiving Voriconazole for treatment or prophylaxis invasive fungal infection , between 2015-2017.

You may qualify if:

• Thai patient in King Chulalongkorn Memorial Hospital , age between 18 and 80 years old
• Receiving Voriconazole for treatment or prophylaxis invasive fungal infection

You may not qualify if:

• Severe hepatic or renal dysfunction
• Pregnancy
• Presence of history of allergy to any Azole antifungal agents
• Death within 2 weeks after treatment of invasive fungal infection

Sponsors & Collaborators

• Chulalongkorn University: lead

Study Sites (1)

Chulalongkorn university

Bangkok, 10330, Thailand

Location

Related Publications (6)

• Hamada Y, Tokimatsu I, Mikamo H, Kimura M, Seki M, Takakura S, Ohmagari N, Takahashi Y, Kasahara K, Matsumoto K, Okada K, Igarashi M, Kobayashi M, Mochizuki T, Nishi Y, Tanigawara Y, Kimura T, Takesue Y. Practice guidelines for therapeutic drug monitoring of voriconazole: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. J Infect Chemother. 2013 Jun;19(3):381-92. doi: 10.1007/s10156-013-0607-8. Epub 2013 May 15. No abstract available.

  PMID: 23673473 BACKGROUND

• Park WB, Kim NH, Kim KH, Lee SH, Nam WS, Yoon SH, Song KH, Choe PG, Kim NJ, Jang IJ, Oh MD, Yu KS. The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial. Clin Infect Dis. 2012 Oct;55(8):1080-7. doi: 10.1093/cid/cis599. Epub 2012 Jul 3.

  PMID: 22761409 BACKGROUND

• Pascual A, Calandra T, Bolay S, Buclin T, Bille J, Marchetti O. Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves efficacy and safety outcomes. Clin Infect Dis. 2008 Jan 15;46(2):201-11. doi: 10.1086/524669.

  PMID: 18171251 BACKGROUND

• Tan K, Brayshaw N, Tomaszewski K, Troke P, Wood N. Investigation of the potential relationships between plasma voriconazole concentrations and visual adverse events or liver function test abnormalities. J Clin Pharmacol. 2006 Feb;46(2):235-43. doi: 10.1177/0091270005283837.

  PMID: 16432276 BACKGROUND

• Ueda K, Nannya Y, Kumano K, Hangaishi A, Takahashi T, Imai Y, Kurokawa M. Monitoring trough concentration of voriconazole is important to ensure successful antifungal therapy and to avoid hepatic damage in patients with hematological disorders. Int J Hematol. 2009 Jun;89(5):592-9. doi: 10.1007/s12185-009-0296-3. Epub 2009 Apr 2.

  PMID: 19340528 BACKGROUND

• Patterson TF, Thompson GR 3rd, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JA, Bennett JE. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Aug 15;63(4):e1-e60. doi: 10.1093/cid/ciw326. Epub 2016 Jun 29.

  PMID: 27365388 BACKGROUND

MeSH Terms

Conditions

Mycoses

Interventions

Voriconazole

Condition Hierarchy (Ancestors)

Bacterial Infections and Mycoses; Infections

Intervention Hierarchy (Ancestors)

Triazoles; Azoles; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: OTHER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 8, 2017
• First Posted: August 24, 2017
• Study Start: January 1, 2016
• Primary Completion: October 1, 2017
• Study Completion: January 1, 2018
• Last Updated: August 24, 2017

Record last verified: 2017-01

Data Sharing

• IPD Sharing: Will not share

Locations

TH (1)