Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Eur J Clin Pharmacol. 2024 Dec;80(12):1845-1855. doi: 10.1007/s00228-024-03756-9. Epub 2024 Sep 9.
This review examines the progress of research on posaconazole therapeutic drug monitoring (TDM) that has focused on differences in the TDM of posaconazole after clinical application in different formulations and in different populations, the factors that affect posaconazole concentrations, the advantages of posaconazole TDM in terms of clinical efficacy and cost savings, and measurement methods.
A literature search (2006 to 2024) was performed in PubMed and Embase with the following search terms: noxafil, posaconazole hydrate, posaconazole, drug monitoring, therapeutic drug monitoring, and TDM. Abstracts of review articles, prospective studies, and retrospective studies were reviewed.
TDM should be implemented earlier for posaconazole tablets and injections than for oral posaconazole suspensions. Posaconazole TDM is beneficial for improving clinical efficacy, and the incidence of breakthrough invasive fungal infections (IFIs) can be significantly reduced by gradually adjusting the posaconazole dose in response to TDM in patients with inadequate trough concentrations. Early TDM allows more patients to achieve target therapeutic posaconazole concentrations. TDM can also facilitate dose adjustments, which reduce the cost of this expensive drug. Different assay techniques, including chromatography, microbiological detection, chemofluorimetry, paper spray mass spectrometry, and capillary electrophoresis, can be used for posaconazole TDM.
Posaconazole TDM has potential clinical utility and cost-saving benefits and could improve the outcomes of IFI treatment.
本综述考察了泊沙康唑治疗药物监测（TDM）的研究进展，重点关注了不同剂型和不同人群在临床应用后泊沙康唑 TDM 的差异、影响泊沙康唑浓度的因素、泊沙康唑 TDM 在临床疗效和成本节约方面的优势，以及测量方法。
在 PubMed 和 Embase 中进行了文献检索（2006 年至 2024 年），使用了以下检索词：noxaf i l、泊沙康唑水合物、泊沙康唑、药物监测、治疗药物监测和 TDM。回顾了综述文章、前瞻性研究和回顾性研究的摘要。
与口服泊沙康唑混悬剂相比，泊沙康唑片剂和注射剂应更早进行 TDM。泊沙康唑 TDM 有利于提高临床疗效，通过根据 TDM 逐渐调整剂量，可以显著降低治疗不足的患者发生侵袭性真菌感染（IFI）的突破性感染率。早期 TDM 可以使更多的患者达到目标治疗性泊沙康唑浓度。TDM 还可以促进剂量调整，从而降低这种昂贵药物的成本。包括色谱法、微生物检测、化学荧光法、纸喷雾质谱和毛细管电泳在内的不同检测技术可用于泊沙康唑 TDM。
泊沙康唑 TDM 具有潜在的临床应用价值和成本节约效益，并能改善IFI 治疗的结局。
