Department of Hematology and Oncology, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
Pharmacoepidemiol Drug Saf. 2012 Sep;21(9):953-63. doi: 10.1002/pds.3278. Epub 2012 May 28.
To assess the role of systemic antifungal drugs as well as the frequency of potential drug interactions and adverse drug events of commonly used antifungals in an unselected haematology/oncology patient cohort.
A prospective analysis was performed in our haematology/oncology department between October 2006 and September 2009. Data were obtained from 250 consecutive patients who received treatment and/or prophylaxis with fluconazole (n = 191), liposomal amphotericin B (n = 105), voriconazole (n = 62), caspofungin (n = 27) and/or posaconazole (n = 22). We performed detailed reviews of patient charts and laboratory values in close cooperation with treating physicians and nursing staff and participated regularly in ward and chart rounds. Potential drug interactions were assessed using the electronic database Micromedex® 1.0 (Healthcare Series).
In terms of adverse drug events, caspofungin (56%) and voriconazole (58%) revealed a slightly more favourable safety profile than liposomal amphotericin B (66%) and posaconazole (64%). We confirmed frequent nephrotoxic effects with the use of liposomal amphotericin B (20%). Regarding potential drug interactions, 97 (66%) of 147 evaluated patients were exposed to at least 1 of 22 different potentially interacting drug combinations involving systemic antifungal agents. Cyclosporine was the most prevalent potentially interacting drug in our cohort.
Systemic antifungal drugs are widely used in the haematology/oncology setting and exhibit numerous potential drug interactions and adverse events in cancer patients. Our results highlight the challenges related to antifungal drugs and should valuably contribute to a safe and efficient application of this increasingly important class of drugs.
评估系统性抗真菌药物在未选择的血液科/肿瘤科患者人群中的作用，以及常用抗真菌药物的潜在药物相互作用和不良药物事件的频率。
我们在血液科/肿瘤科进行了一项前瞻性分析，时间为 2006 年 10 月至 2009 年 9 月。数据来自 250 例连续接受氟康唑（n=191）、脂质体两性霉素 B（n=105）、伏立康唑（n=62）、卡泊芬净（n=27）和/或泊沙康唑（n=22）治疗和/或预防的患者。我们与治疗医生和护理人员密切合作，详细审查患者病历和实验室值，并定期参加病房和病历查房。使用电子数据库 Micromedex® 1.0（Healthcare Series）评估潜在的药物相互作用。
在不良药物事件方面，卡泊芬净（56%）和伏立康唑（58%）的安全性略优于脂质体两性霉素 B（66%）和泊沙康唑（64%）。我们证实了使用脂质体两性霉素 B 时频繁出现肾毒性（20%）。关于潜在的药物相互作用，在 147 例评估的患者中，有 97 例（66%）至少接触了 22 种不同的潜在相互作用的药物组合中的 1 种，这些组合涉及系统性抗真菌药物。环孢素是我们队列中最常见的潜在相互作用药物。
系统性抗真菌药物在血液科/肿瘤科广泛使用，在癌症患者中存在许多潜在的药物相互作用和不良事件。我们的结果突出了与抗真菌药物相关的挑战，这对于安全有效地应用这一日益重要的药物类别具有重要价值。
