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Kozuch JM, Burt C, Afshar K, Aslam S, Yung G, Mariski M, Golts E, Feist A. Difference in immunosuppressant dose requirement when transitioning to isavuconazole from other azoles in thoracic transplant recipients. Transpl Infect Dis 2024; 26:e14209. [PMID: 38059638 DOI: 10.1111/tid.14209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/21/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
The triazole antifungal isavuconazole (ISAVU) is used for prevention and treatment of fungal infections in solid organ transplant (SOT). SOT recipients commonly need to transition from one azole to another due to breakthrough infection, toxicity, or other reasons. The purpose of our study was to evaluate the effect of ISAVU on immunosuppressant concentrations in thoracic transplant recipients when ISAVU was started de novo or transitioned from another azole. We conducted a single-center retrospective cohort study including 68 patients (51 lung, 14 heart, and 3 heart/lung transplant). Concentration to dosage ratios (C/D) of immunosuppressants were assessed at baseline, day 3, and weekly for 9 weeks. When starting ISAVU de novo, we observed a temporary doubling of tacrolimus exposure. Cyclosporine and sirolimus required dose decreases. Tacrolimus C/D increased by 110% at day 3 in patients started on ISAVU de novo then returned to baseline C/D ± 17% weeks 2-9 (n = 8). One cyclosporine patient started on ISAVU de novo had variable C/D, and C/D increased by 219% ± 72% in 2 sirolimus patients. When transitioning from other azoles, tacrolimus and cyclosporine required about twice the initial dose. After week 1, tacrolimus C/D decreased by 53% ± 6% in patients transitioned from posaconazole (n = 33), voriconazole (n = 14), or fluconazole (n = 2). Cyclosporine C/D decreased by 45% ± 16% in patients transitioning from other azoles (posaconazole [n = 2], voriconazole [n = 2], fluconazole [n = 1]). Sirolimus C/D decreased by 73% ± 13% in patients transitioned from posaconazole (n = 7). Aside from the initial loading phase, ISAVU had a lesser degree of interaction with immunosuppressants than other azoles in loading phase, ISAVU had a lesser degree of interaction with immunosuppressants than other azoles in adjustments for the 4-week period after initiating antifungal therapy with ISAVU or switching from another agent.
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Affiliation(s)
- Jade M Kozuch
- Department of Pharmacy, University of California San Diego, La Jolla, California, USA
| | - Carrie Burt
- Department of Pharmacy, Scripps Memorial Hospital, La Jolla, California, USA
| | - Kamyar Afshar
- Division of Pulmonary and Critical Care, University of California San Diego, La Jolla, California, USA
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Gordon Yung
- Division of Pulmonary and Critical Care, University of California San Diego, La Jolla, California, USA
| | - Mark Mariski
- Department of Pharmacy, University of California San Diego, La Jolla, California, USA
| | - Eugene Golts
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California, USA
| | - Ashley Feist
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
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Doligalski CT, Anger LB, Dick T, Feist A, Harris M, Masters B, Pilch N, Quan D, Sparkes T, Suarez T, Yakubu I. Considerations and approaches to expansion of solid organ transplant pharmacist services. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Travis Dick
- Department of Pharmacy University of Rochester Medical Center Rochester New York USA
| | - Ashley Feist
- Department of Pharmacy UC San Diego San Diego California USA
| | - Matt Harris
- Department of Pharmacy Duke University Hospitals Durham North Carolina USA
| | - Brian Masters
- Department of Pharmacy University of Maryland Medical Center Baltimore Maryland USA
| | - Nicole Pilch
- Department of Transplant Medical University of South Carolina Charleston South Carolina USA
| | - David Quan
- Department of Clinical Pharmacy UCSF Health San Francisco California USA
| | - Tracy Sparkes
- Department of Pharmacy University of Maryland Medical Center Baltimore Maryland USA
| | - Tricia Suarez
- Department of Pharmacy University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Idris Yakubu
- Department of Pharmacy Virginia Commonwealth University Health System Richmond Virginia USA
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Kozuch JM, Feist A, Yung G, Awdishu L, Hays S, Singer JP, Florez R. Low dose posaconazole delayed release tablets for fungal prophylaxis in lung transplant recipients. Clin Transplant 2018; 32:e13300. [PMID: 29806967 DOI: 10.1111/ctr.13300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/28/2022]
Abstract
In November 2013, posaconazole delayed release (DR) tablets were approved by the FDA with the labeled dose of 300 mg daily for fungal prophylaxis. There are no studies demonstrating the appropriate dose in lung transplant recipients (LTR). We performed a 2-center retrospective cohort study of LTR taking posaconazole DR tablets for prophylaxis between January 2014 and January 2017. Mean serum trough concentrations and percentage of measurements ≥0.7 mcg/mL were compared by daily dose. Forty-nine subjects with 156 steady state serum posaconazole concentrations were included. There was a significant difference in percentage of first measured concentration ≥0.7 mcg/mL by initial daily dose (P = .04). The mean serum posaconazole concentration by dose was 0.9 (±0.42) mcg/mL for 100 mg daily, 1.66 (±0.91) mcg/mL for 200 mg daily, 2.39 (±1.49) mcg/mL for 300 mg daily, and 1.75 (±0.21) mcg/mL for 400 mg daily (P < .001). Mean concentrations were at goal in 63.3%, 96.9%, 94.9%, and 100% of subjects taking 100 mg, 200 mg, 300 mg, and 400 mg daily respectively (P = .04). Our results suggest that doses less than 300 mg daily of posaconazole DR tablets may be adequate to achieve target serum concentrations in LTR. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Jade M Kozuch
- Department of Pharmacy, UC San Diego Health, San Diego, CA, USA
| | - Ashley Feist
- Department of Pharmacy, UC San Diego Health, San Diego, CA, USA
| | - Gordon Yung
- Division of Pulmonary and Critical Care Medicine, UC San Diego Health, San Diego, CA, USA
| | - Linda Awdishu
- Department of Pharmacy, UC San Diego Health, San Diego, CA, USA
| | - Steven Hays
- Division of Pulmonary Medicine, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Jonathan P Singer
- Division of Pulmonary Medicine, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Rebecca Florez
- Department of Pharmacy, San Francisco Medical Center, University of California, San Francisco, CA, USA
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Nguyen V, Smith M, Belyk M, Brambatti M, Braun O, Adler E, G V, Mariski M, Stevens C, Feist A. INR Remote Monitoring is Associated with Improved Time in Therapeutic Range Following Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Deininger K, Hirsch J, Graveline S, Feist A, Smith S, Reich J, LaFleur J, Ambardekar A, Lindenfeld J, Aquilante C. Relationship Between Patient-Perceived Treatment Burden and Health-Related Quality of Life in Heart Transplant Recipients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Waldman G, Mariski M, Feist A, Awdishu L, Afshar K, Yung G. Prevalence of Venous Thromboembolic Events in ILD Lung Transplant Patients Treated with Sirolimus. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Dang C, Feist A, Awdishu L, Reed S, Yung G. Concurrent Use of Sirolimus and Voriconazole: Assessing Long Term Safety and Dosing Strategies. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Feist A, Lee R, Osborne S, Lane J, Yung G. Increased incidence of cutaneous squamous cell carcinoma in lung transplant recipients taking long-term voriconazole. J Heart Lung Transplant 2012; 31:1177-81. [DOI: 10.1016/j.healun.2012.05.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 05/06/2012] [Accepted: 05/14/2012] [Indexed: 11/25/2022] Open
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Grimm B, Schneider U, Brückmann A, Köfer B, Feist A, Schleußner E. Komplikation einer Schwangerschaft durch familiäre hyperkaliämische paroxysmale Lähmung. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Case reports and serological work have raised the possibility that chlamydias can infect the placenta and thus harm the fetus. We investigated the involvement of Chlamydia in a series of 195 unselected cases of spontaneous abortion or miscarriage. Formalin-fixed placental tissues from all cases were examined immunohistochemically, for the presence of chlamydial lipopolysaccharide, as well as histopathologically. A serum sample was collected from 187 of the patients for detection of anti-chlamydial antibodies by microimmunofluorescence. All placental sections were negative for chlamydial antigen. Serological findings indicated that 8 patients had been in contact with C. trachomatis, 15 patients with C. pneumoniae, and none with C. psittaci. A few cases of perivillitis or intervillitis were detected, but none exhibited the intracytoplasmic inclusions typical of C. psittaci. Although these results are negative a search for Chlamydia in abortion materials should be encouraged.
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Affiliation(s)
- A Feist
- Institute of Veterinary Pathology, University of Zurich, Switzerland
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Feist A, Hanitsch S. [Experimental studies on changes in the design pattern of the Staegemann bridge]. Zahntechnik (Berl) 1987; 28:23-5. [PMID: 3296552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Feist A, Balan E. [Longitudinal studies of periodontal bone destruction]. Stomatol DDR 1984; 34:207-209. [PMID: 6591572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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