Alsowaida Yazed S, Alamer Ahmad, Thabit Abrar K, Almulhim Abdulaziz S, Aleissa Muneerah M, Kalbasi Alireza, Eljaaly Khaled, Almangour Thamer A, Erstad Brian L
Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
Department of Clinical Pharmacy, College of Pharmacy, Hail University, Hail, Saudi Arabia.
Am J Health Syst Pharm. 2023 Apr 8;80(8):503-517. doi: 10.1093/ajhp/zxad021.
Echinocandins are favored drugs for the treatment of fungal infections. There is growing evidence that obese patients treated with echinocandins have lower exposures due to pharmacokinetic (PK) alterations. We conducted a scoping review to characterize, evaluate, and summarize the available evidence on echinocandins exposures in obese patients.
A comprehensive search of PubMed, Embase, and Cochrane Library for studies on echinocandins published from database inception to October 28, 2022, was conducted using PRISMA-ScR methodology. A total of 25 studies comprising more than 3,174 subjects (8 micafungin studies, 7 caspofungin studies, 9 anidulafungin studies, and 1 rezafungin study) were included in this review. Seventeen studies reported lower echinocandins exposures in overweight and obese individuals compared with normal-weight individuals; the authors of these studies recommended dose adjustments. Conversely, 8 studies did not find significant differences in echinocandin exposure among subjects in varying body weight categories. Clinicians may consider dose adjustments of echinocandins in obese patients; however, there is limited evidence on the ideal dose adjustment strategy to overcome the low echinocandins exposures in obese patients.
This scoping review shed light on a growing body of evidence indicating that obese patients have lower echinocandin exposures relative to targeted PK indices, which may lead to negative therapeutic implications. Currently, a lack of high-quality evidence impedes reaching consensus on recommendations for echinocandin dosing adjustment in obese patients. Future research evaluating the optimal echinocandin dosing strategy for obese patients is needed.
棘白菌素类药物是治疗真菌感染的常用药物。越来越多的证据表明，接受棘白菌素类药物治疗的肥胖患者由于药代动力学（PK）改变而暴露量较低。我们进行了一项范围综述，以描述、评估和总结肥胖患者中棘白菌素类药物暴露的现有证据。
使用PRISMA-ScR方法对PubMed、Embase和Cochrane图书馆进行了全面检索，以查找从数据库建立到2022年10月28日发表的关于棘白菌素类药物的研究。本综述共纳入25项研究，涉及3174多名受试者（8项米卡芬净研究、7项卡泊芬净研究、9项阿尼芬净研究和1项瑞扎芬净研究）。17项研究报告称，与正常体重个体相比，超重和肥胖个体的棘白菌素类药物暴露量较低；这些研究的作者建议调整剂量。相反，8项研究未发现不同体重类别的受试者在棘白菌素类药物暴露方面存在显著差异。临床医生可能会考虑对肥胖患者调整棘白菌素类药物的剂量；然而，关于克服肥胖患者棘白菌素类药物低暴露的理想剂量调整策略的证据有限。
本范围综述揭示了越来越多的证据表明，相对于目标PK指标，肥胖患者的棘白菌素类药物暴露量较低，这可能会产生负面的治疗影响。目前，缺乏高质量的证据阻碍了就肥胖患者棘白菌素类药物剂量调整建议达成共识。未来需要开展研究，评估肥胖患者的最佳棘白菌素类药物给药策略。
