WHAT IS KNOWN AND OBJECTIVE

Voriconazole is a broad-spectrum antifungal agent and is mainly metabolized by the liver, yet there have been no reports about voriconazole treatment in patients with Child-Pugh class C cirrhosis. The objective of this study was to investigate the pharmacokinetic profile and safety of voriconazole treatment in this cohort of patients.

METHODS

A retrospective, multicenter study was performed in patients with Child-Pugh class C cirrhosis who received a voriconazole maintenance dose of 100 mg twice daily (group A) or 200 mg daily (group B) orally or intravenously. All voriconazole C were measured by high-performance liquid chromatography, and voriconazole-related adverse events were defined according to Common Terminology Criteria for Adverse Events. The relationship between voriconazole C and adverse events was explored using logistic regression model.

RESULTS AND DISCUSSION

A total of 51 voriconazole C were monitored from 34 patients. The C of voriconazole was 4.42 ± 2.08 and 5.42 ± 1.96 mg/L in groups A and B, respectively. The proportion of voriconazole C over the upper limit of therapeutic level (5 mg/L) in groups A and B was 34.48% and 47.62%, respectively. Additionally, 23.5% (8/34) of patients exhibited signs of voriconazole-related adverse events, and 87.5% (7/8) of adverse events occurred within the first week after voriconazole treatment. Logistic regression model showed that there was a positive correlation between voriconazole C and the incidence of adverse reactions. Voriconazole C value of 4.5 mg/L was associated with a 20% probability of adverse events.

WHAT IS NEW AND CONCLUSION

The voriconazole maintenance dose of 100 mg twice daily or 200 mg daily orally or intravenously may be inappropriate in patients with Child-Pugh class C cirrhosis because of the higher voriconazole C and higher incidence of adverse events. Monitoring voriconazole C earlier is extremely important to prevent the occurrence of voriconazole-related adverse reactions.