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Posaconazole Therapeutic Drug Monitoring in Daily Practice: A Single-Center Analysis
Ugur Balaban1, Emre Kara1, Asli Pinar2
1Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Türkiye.
Summary
Therapeutic drug monitoring (TDM) for posaconazole is crucial due to variable plasma levels. This study shows TDM helps optimize antifungal prophylaxis and treatment, especially in patients with subtherapeutic drug exposure.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Posaconazole plasma levels exhibit significant inter-patient variability.
- Therapeutic drug monitoring (TDM) is essential for optimizing posaconazole efficacy.
- Limited access to TDM in clinical settings necessitates real-world practice evaluation.
Purpose of the Study:
- To assess the impact of posaconazole TDM in a tertiary care hospital.
- To evaluate the effectiveness of TDM in achieving target posaconazole plasma concentrations.
- To identify factors associated with subtherapeutic posaconazole levels.
Main Methods:
- A retrospective study of 35 patients receiving posaconazole delayed-release tablets.
- Analysis of 74 TDM samples collected between January 2022 and December 2023.
- Evaluation of target attainment, subtherapeutic levels, and associated clinical outcomes.
Main Results:
- 74.3% of posaconazole concentrations were within the target range.
- Subtherapeutic levels (<0.7 mg/L for prophylaxis, <1 mg/L for treatment) were found in 19 samples.
- Factors like diarrhea and non-adherence were linked to subtherapeutic levels; breakthrough infections occurred in two patients with low prophylactic levels.
Conclusions:
- Posaconazole TDM is vital for optimizing antifungal prophylaxis and treatment.
- TDM aids in identifying and managing patients at risk of subtherapeutic posaconazole exposure.
- Real-world data support the critical role of TDM in clinical practice.
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