Applying Pharmacogenomics to Antifungal Selection and Dosing: Are We There Yet?

PURPOSE OF REVIEW

This review summarizes recent literature for applying pharmacogenomics to antifungal selection and dosing, providing an approach to implementing antifungal pharmacogenomics in clinical practice.

RECENT FINDINGS

The Clinical Pharmacogenetics Implementation Consortium published guidelines on and voriconazole, with recommendations to use alternative antifungals or adjust voriconazole dose with close therapeutic drug monitoring (TDM). Recent studies demonstrate an association between phenotype and voriconazole levels, clinical outcomes, and adverse events. Additionally, -guided preemptive dose adjustment demonstrated benefit in two prospective studies for prophylaxis. Pharmacokinetic-pharmacodynamic modeling studies have generated proposed voriconazole treatment doses based on phenotypes, with further validation studies needed.

SUMMARY

Sufficient evidence is available for implementing -guided voriconazole selection and dosing among select patients at risk for invasive fungal infections. The institution needs appropriate infrastructure for pharmacogenomic testing, integration of results in the clinical decision process, with TDM confirmation of goal trough achievement, to integrate antifungal pharmacogenomics into routine clinical care.