Dose adjustment of immunosuppressants during co-administration of posaconazole: a systematic review

作者：Fu, Chengcheng; Chen, Jia; Xu, Yang; Wu, Depei^*

来源：Clinical and Investigative Medicine, 2018, 41(1): E5-E15.

DOI：10.25011/cim.v41i1.29458

• STEM-CELL TRANSPLANT
• VERSUS-HOST-DISEASE
• AZOLE ANTIFUNGALS
• PEDIATRIC-PATIENTS
• ORAL POSACONAZOLE
• DRUG-INTERACTIONS
• FUNGAL-INFECTION
• RECIPIENTS
• TACROLIMUS
• PROPHYLAXIS

Purpose: The purpose of this retrospective study was to analyze the dose adjustment of immunosuppressants (cyclosporine, tacrolimus and sirolimus) for the patients with allogeneic hematopoietic stem cell and solid-organ (heart/lung) transplantation during co-administration of posaconazole. @@@ Methods: MEDLINE, EMBASE and Cochrane Library were searched from January 1, 2000 to June 30, 2017 for clinical reports of patients who received allogeneic hematopoietic stem cell and organ transplantation and were co-administered posaconazole and immunosuppressants (cyclosporine, tacrolimus or sirolimus). @@@ Results: Seven studies were included in the systematic review with a total of 215 patients. Five studies involved hematopoietic stem cell transplant, one heart transplant and one lung transplant. In general, the co-administration of posaconazole with sirolimus, tacrolimus or cyclosporine necessitated immunosuppressant dose reductions to maintain the levels of the drug in the optimal therapeutic range. Reported dose reductions were 50%-68% for sirolimus, 75% for tacrolimus and 14%-49% for cyclosporine. The findings were similar for hematopoietic stem cell, heart or lung transplantation studies. @@@ Conclusion: Our findings indicate that, when posaconazole is co-administered, the dosage of sirolimus and tacrolimus should be reduced by 60%-70% and for cyclosporine and by 30%-40% following allogeneic hematopoietic stem cell and solid-organ transplantation.

• 出版日期2018-3
• 单位苏州大学