Posaconazole trough concentrations are not influenced by inflammation: A prospective study

Area of Science:

• Pharmacology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Inflammation can alter the metabolism of certain drugs, including antifungal agents like voriconazole.
• Posaconazole, a broad-spectrum antifungal, undergoes limited metabolism by cytochrome P450 enzymes, relying more on phase 2 enzyme systems.

Purpose of the Study:

• To investigate the impact of inflammation on posaconazole serum trough concentrations.
• To determine if C-reactive protein (CRP) levels correlate with posaconazole concentrations in patients.

Main Methods:

• Prospective observational study involving patients aged 18+ receiving posaconazole.
• Collected routine samples for posaconazole and CRP concentrations.
• Performed longitudinal data analysis to assess correlations, adjusting for confounding factors.

Main Results:

• Analyzed data from 55 patients with 511 posaconazole samples.
• Found that only the posaconazole daily dose (mg/kg) significantly influenced concentrations (P < 0.0001).
• Posaconazole concentrations were not significantly influenced by CRP levels (P = 0.77), indicating inflammation did not affect drug levels.

Conclusions:

• Posaconazole serum concentrations are not influenced by inflammation, as measured by CRP.
• Frequent therapeutic drug monitoring of posaconazole during inflammation or post-infection is not required.
• This supports current dosing strategies without the need for increased monitoring in inflammatory states.