住院患者中与霉菌活性三唑类药物相关的药物相互作用
Drug-Drug Interaction Associated with Mold-Active Triazoles among Hospitalized Patients.
作者信息
Andes David, Azie Nkechi, Yang Hongbo, Harrington Rachel, Kelley Caroline, Tan Ruo-Ding, Wu Eric Q, Franks Billy, Kristy Rita, Lee Edward, Khandelwal Nikhil, Spalding James
机构信息
Departments of Medicine and Medical Microbiology and Immunology, University of Wisconsin, Madison, Wisconsin, USA
Astellas Pharma Global Development, Inc., Northbrook, Illinois, USA.
出版信息
Antimicrob Agents Chemother. 2016 May 23;60(6):3398-406. doi: 10.1128/AAC.00054-16. Print 2016 Jun.
The majority of hospitalized patients receiving mold-active triazoles are at risk of drug-drug interactions (DDIs). Efforts are needed to increase awareness of DDIs that pose a serious risk of adverse events. Triazoles remain the most commonly utilized antifungals. Recent developments have included the mold-active triazoles (MATs) itraconazole, voriconazole, and posaconazole, which are first-line agents for the treatment of filamentous fungal infections but have the potential for DDIs. This objective of this study was to evaluate the prevalence of triazole DDIs. Hospitalized U.S. adults with MAT use were identified in the Cerner HealthFacts database, which contained data from over 150 hospitals (2005 to 2013). The severities of DDIs with MATs were categorized, using drug labels and the drug information from the Drugdex system (Thompson Micromedex), into four groups (contraindicated, major, moderate, and minor severity). DDIs of minor severity were not counted. A DDI event was considered to have occurred if the following two conditions were met: (i) the patient used at least one drug with a classification of at least a moderate interaction with the MAT during the hospitalization and (ii) there was a period of overlap between the administration of the MAT and that of the interacting drug of at least 1 day. A total of 6,962 hospitalizations with MAT use were identified. Among them, 88% of hospitalizations with voriconazole use, 86% of hospitalizations with itraconazole use, and 93% of hospitalizations with posaconazole use included the use of a concomitant interacting drug. A total of 68% of hospitalizations with posaconazole use, 34% of hospitalizations with itraconazole use, and 20% of hospitalizations with voriconazole use included the use of at least one drug with a DDI of contraindicated severity. A total of 83% of hospitalizations with posaconazole use, 61% of hospitalizations with itraconazole use, and 82% of hospitalizations with voriconazole use included the use of at least one drug that resulted in a severe DDI. The findings of this study demonstrate that a majority of hospitalized patients receiving MAT are at risk for severe drug-drug interactions and highlight the need for antifungal stewardship.
大多数接受具有抗霉菌活性三唑类药物治疗的住院患者存在药物相互作用（DDIs）风险。需要做出努力，提高对可能引发严重不良事件的药物相互作用的认识。三唑类药物仍然是最常用的抗真菌药物。近期的进展包括具有抗霉菌活性的三唑类药物（MATs）伊曲康唑、伏立康唑和泊沙康唑，它们是治疗丝状真菌感染的一线药物，但存在药物相互作用的可能性。本研究的目的是评估三唑类药物相互作用的发生率。在Cerner HealthFacts数据库中识别出使用MATs的美国住院成人患者，该数据库包含来自150多家医院的数据（2005年至2013年）。根据药品标签和Drugdex系统（Thompson Micromedex）的药物信息，将与MATs发生的药物相互作用的严重程度分为四组（禁忌、严重、中度和轻度）。轻度药物相互作用未计算在内。如果满足以下两个条件，则认为发生了药物相互作用事件：（i）患者在住院期间使用了至少一种与MAT具有至少中度相互作用分类的药物，以及（ii）MAT给药与相互作用药物给药之间存在至少1天的重叠期。总共识别出6962例使用MATs的住院病例。其中，使用伏立康唑的住院病例中有88%、使用伊曲康唑的住院病例中有86%以及使用泊沙康唑的住院病例中有93%包括使用了一种伴随的相互作用药物。使用泊沙康唑的住院病例中有68%、使用伊曲康唑的住院病例中有34%以及使用伏立康唑的住院病例中有20%包括使用了至少一种具有禁忌严重程度药物相互作用的药物。使用泊沙康唑的住院病例中有83%、使用伊曲康唑的住院病例中有61%以及使用伏立康唑的住院病例中有82%包括使用了至少一种导致严重药物相互作用的药物。本研究结果表明，大多数接受MATs治疗的住院患者存在严重药物相互作用风险，并突出了抗真菌管理的必要性。
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