Combined use of CYP2C19 polymorphism analysis and CRP test to guide the use of voriconazole in the prevention and treatment of invasive fungal infections in patients with hematological diseases
ZHOU Li-juan
SANG Zhi-hui
LI Hui-hong
SHEN Ming-hui
GUO Zhi-qiang
HE Meng
QIN Fu-li
Abstract：Objective:To investigate the clinical significance of CYP2C19 polymorphism analysis and C-reactive protein(CRP)test for guiding therapeutic drug monitoring(TDM)of voriconazole(VCZ)in patients with hematologic diseases and invasive fungal infections.Methods:A prospective study was conducted in 139 patients with invasive fungal infections in the Department of Hematology,Zhengzhou Central Hospital affiliated to Zhengzhou University.The patients were divided into group A(without ADRs)and group B(with ADRs).CYP2C19 genotypes were detected by RT-PCR and Cmin by RP-HPLC.The Cmin and clinical efficacy in different gene phenotypes and CRP stratification were compared between the two groups.The correlation of CYP2C19 genotype,CRP,Cmin with VCZ-induced adverse drug reaction was analyzed by Logistic regression.Results:The ratios of UM/RM/PM and IM patients in group A were significantly lower(P＜0.05)or higher(P＜0.05)than those in group B,respectively.There was no significant difference in other general clinical data and efficacy between the two groups(all P＞0.05).The VCZ-Cmin in group A was significantly lower than that in group B(P=0.009).There was no significant difference in VCZ-Cmin among the CYP2C19 gene phenotypes(P=0.137).However,the VCZ-Cmin was significantly higher in PM patients than that in IM patients(P=0.048).A significant difference was observed for VCZ-Cmin among different levels of CRP(P=0.015).The increase of VCZ-Cmin was an independent risk factor for VCZ-induced liver toxicity.Conclusion:The combination of CYP2C19 gene phenotype and CRP level may guide TDM for individualized VCZ administration,helping patients to achieve target Cmin,thus improving efficacy and safety.
Keywords：voriconazoleCYP2C19serum tough concentrationclinical effectadverse reaction
Publication Date：2024-11-30
Online Publishing Date：2026-08-14(First online date of this platform, not the publication date of the document)
Pages：7( 2352-2358 )