Teng GJ, Bai XR, Zhang L, Liu HJ, Nie XH. Remission of hepatotoxicity in chronic pulmonary aspergillosis patients after lowering trough concentration of voriconazole. World J Clin Cases 2020; 8(20): 4700-4707 [PMID: 33195637 DOI: 10.12998/wjcc.v8.i20.4700]
Corresponding Author of This Article
Xiu-Hong Nie, PhD, Chief Doctor, Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. xiuhongnie@126.com
Research Domain of This Article
Mycology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2020; 8(20): 4700-4707 Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4700
Remission of hepatotoxicity in chronic pulmonary aspergillosis patients after lowering trough concentration of voriconazole
Guo-Jie Teng, Xiang-Rong Bai, Lin Zhang, Hong-Jun Liu, Xiu-Hong Nie
Guo-Jie Teng, Lin Zhang, Xiu-Hong Nie, Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing 100053, China
Xiang-Rong Bai, Pharmacy Department, Xuanwu Hospital Capital Medical University, Beijing 100053, China
Hong-Jun Liu, Department of Evidence-based Medicine, Xuanwu Hospital Capital Medical University, Beijing, China, Beijing 100053, China
Author contributions: Teng GJ and Bai XR performed the diagnostic investigations and treatments; Teng GJ and Zhang L acquired the data and contributed to manuscript drafting; Teng GJ and Liu HJ were responsible for the statistics; Nie XH was responsible for revising the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Institutional review board statement: The study was approved by the Institutional Review Board of Xuanwu Hospital, Capital Medical University, Beijing, No. 2019-118.
Informed consent statement: All study participants provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this manuscript.
Data sharing statement: The original anonymous dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiu-Hong Nie, PhD, Chief Doctor, Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. xiuhongnie@126.com
Received: May 17, 2020 Peer-review started: May 17, 2020 First decision: July 25, 2020 Revised: July 29, 2020 Accepted: September 1, 2020 Article in press: September 1, 2020 Published online: October 26, 2020 Processing time: 161 Days and 21.3 Hours
ARTICLE HIGHLIGHTS
Research background
Voriconazole is often used as the first-line agent for chronic pulmonary aspergillosis (CPA) treatment. However, some patients develop hepatotoxicity that eventually leads to discontinuation of treatment.
Research motivation
The optimal trough concentration of voriconazole in patients with CPA is currently uncertain.
Research objectives
After reducing the lower limit of trough concentration to 0.5 µg/mL, the improvement trend of liver function and therapeutic effect on the patients were recorded.
Research methods
This study retrospectively analyzed 12 adult CPA patients who developed hepatotoxicity during voriconazole treatment between January 2013 to January 2019. In these patients, the oral dose was reduced and the lower limit of voriconazole trough concentration was maintained at more than 0.5 µg/mL. Data were collected and analyzed for parameters.
Research results
Hepatotoxicity was mainly manifested as significantly increased level of gamma-glutamyltransferase in 12 patients. After lowering the trough concentrations, the hepatotoxicity was alleviated in all patients. However, gamma-glutamyltransferase levels declined slowly. After reducing the lower limit of trough concentration to 0.5 µg/mL, a certain clinical effects was still maintained.
Research conclusions
Reducing the lower limit of the voriconazole trough concentration to 0.5 µg/mL can help alleviate hepatotoxicity and maintain a certain clinical efficacy in CPA patients; however, patients should be closely monitored.
Research perspectives
This single-center retrospective study had a small sample size. Hence, additional multi-center prospective randomized study studies should be conducted to reveal the optimal trough concentration of voriconazole in CPA patients.
