TY - JOUR
T1 - A large retrospective assessment of voriconazole exposure in patients treated with extracorporeal membrane oxygenation
AU - Van Daele, Ruth
AU - Bekkers, Britt
AU - Lindfors, Mattias
AU - Broman, Lars Mikael
AU - Schauwvlieghe, Alexander
AU - Rijnders, Bart
AU - Hunfeld, Nicole G.M.
AU - Juffermans, Nicole P.
AU - Taccone, Fabio Silvio
AU - Sousa, Carlos Antônio Coimbra
AU - Jacquet, Luc Marie
AU - Laterre, Pierre François
AU - Nulens, Eric
AU - Grootaert, Veerle
AU - Lyster, Haifa
AU - Reed, Anna
AU - Patel, Brijesh
AU - Meersseman, Philippe
AU - Debaveye, Yves
AU - Wauters, Joost
AU - Vandenbriele, Christophe
AU - Spriet, Isabel
N1 - Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/7/20
Y1 - 2021/7/20
N2 - Background: Voriconazole is one of the first‐line therapies for invasive pulmonary aspergillosis. Drug concentrations might be significantly influenced by the use of extracorporeal membrane oxygenation (ECMO). We aimed to assess the effect of ECMO on voriconazole exposure in a large patient population. Methods: Critically ill patients from eight centers in four countries treated with voriconazole during ECMO support were included in this retrospective study. Voriconazole concentrations were collected in a period on ECMO and before/after ECMO treatment. Multivariate analyses were performed to evaluate the effect of ECMO on voriconazole exposure and to assess the impact of possible saturation of the circuit’s binding sites over time. Results: Sixty‐nine patients and 337 samples (190 during and 147 before/after ECMO) were analyzed. Subtherapeutic concentrations (<2 mg/L) were observed in 56% of the samples during ECMO and 39% without ECMO (p = 0.80). The median trough concentration, for a similar daily dose, was 2.4 (1.2–4.7) mg/L under ECMO and 2.5 (1.4–3.9) mg/L without ECMO (p = 0.58). Extensive inter‐and intrasubject variability were observed. Neither ECMO nor squared day of ECMO (saturation) were retained as significant covariates on voriconazole exposure. Conclusions: No significant ECMO‐effect was observed on voriconazole exposure. A large proportion of patients had voriconazole subtherapeutic concentrations.
AB - Background: Voriconazole is one of the first‐line therapies for invasive pulmonary aspergillosis. Drug concentrations might be significantly influenced by the use of extracorporeal membrane oxygenation (ECMO). We aimed to assess the effect of ECMO on voriconazole exposure in a large patient population. Methods: Critically ill patients from eight centers in four countries treated with voriconazole during ECMO support were included in this retrospective study. Voriconazole concentrations were collected in a period on ECMO and before/after ECMO treatment. Multivariate analyses were performed to evaluate the effect of ECMO on voriconazole exposure and to assess the impact of possible saturation of the circuit’s binding sites over time. Results: Sixty‐nine patients and 337 samples (190 during and 147 before/after ECMO) were analyzed. Subtherapeutic concentrations (<2 mg/L) were observed in 56% of the samples during ECMO and 39% without ECMO (p = 0.80). The median trough concentration, for a similar daily dose, was 2.4 (1.2–4.7) mg/L under ECMO and 2.5 (1.4–3.9) mg/L without ECMO (p = 0.58). Extensive inter‐and intrasubject variability were observed. Neither ECMO nor squared day of ECMO (saturation) were retained as significant covariates on voriconazole exposure. Conclusions: No significant ECMO‐effect was observed on voriconazole exposure. A large proportion of patients had voriconazole subtherapeutic concentrations.
UR - http://www.scopus.com/inward/record.url?scp=85110499102&partnerID=8YFLogxK
U2 - 10.3390/microorganisms9071543
DO - 10.3390/microorganisms9071543
M3 - Article
AN - SCOPUS:85110499102
SN - 2076-2607
VL - 9
JO - Microorganisms
JF - Microorganisms
IS - 7
M1 - 1543
ER -