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Unexpected renal influence on isavuconazole trough concentrations: two case reports and literature review
Hui Li1, Xiaoshuang He1, Qiuya Lu2
1Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Abstract:
Isavuconazole (ISA) is a first-line treatment for invasive aspergillosis, with routine therapeutic drug monitoring (TDM) typically deemed unnecessary. Although the drug label and prior studies suggest renal function does not affect ISA pharmacokinetics, our findings in two high-risk patients challenge this perspective, showing an inverse correlation between ISA trough concentrations and estimated glomerular filtration rate (eGFR). Trough concentrations exceeding the reported toxicity threshold were associated with adverse drug reactions (ADRs). Given the limited sample size, large-scale retrospective and prospective studies are urgently needed to confirm the impact of renal function on ISA and to develop individualized TDM strategies that optimize efficacy and minimize toxicity.
Insights
Isavuconazole (ISA) monitoring is usually not needed for invasive aspergillosis. However, impaired kidney function may increase ISA levels, potentially causing adverse drug reactions, warranting further study.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Isavuconazole (ISA) is a crucial antifungal agent for invasive aspergillosis.
- Routine therapeutic drug monitoring (TDM) for ISA is generally not recommended.
- Existing data suggest renal function does not significantly impact ISA pharmacokinetics.
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