Evaluation of voriconazole guided by CYP2C19 gene polymorphism in the treatment of patients with invasive fungal infection

doi:10.3969/j.issn.1006-7795.2018.03.020

Abstract

Abstract: Objective To determine effects of CYP2C19 gene polymorphism on standardized treatment of voriconazole in critically ill patients with invasive fungal infections and provide reference for clinical rational medication.Methods A non-randomized controlled study was used to compare the therapeutic efficacy, adverse reactions, and cost-effectiveness of genetically-directed voriconazole regimens and conventional voriconazole regimens in patients with invasive fungal infections. The PCR-RFLP method was used to detect the genetic polymorphism of CYP2C19 in patients.Results A total of 80 samples were included, including 40 test groups that were genotyped and 40 non-contemporaneous controls that were treated with conventional voriconazole for invasive fungal infections. The gene testers analyzed three sites of CYP2C19, a total of five two-site genotype combinations, including:681GG-636GG of an extensive metabolizer (EM), 681GA-636GG of an intermediate metabolizer (lM), and frequencies of 681GG-636GA and poor metabolites (PM) 681AA-636GG and 681GA-636GA were 12.17%, 52.16%, 6.22%, 17.54% and 11.91%, respectively. The therapeutic effect, cost-effectiveness and adverse reactions were significantly different in the EM group, IM group and PM group (P<0.05), and the PM group was significantly higher than the IM group, and the IM group was significantly higher than the EM group (P<0.05). Retrospective comparison with the control group showed that the experimental group was significantly lower than the control group in the average length of hospital stay and antifungal treatment costs.Conclusion CYP2C19 polymorphism can significantly impact the cost of standardized treatment,dosage, effects and adverse reactions of voriconazole,indicating that pharmacogenetics is important for rationalized medication of voriconazole.

Key words: voriconazolc, CYP2C19, polymorphism, invasive fungal infections, critically ill patients

CLC Number:

R459.7

Niu Bingyin, Wang Guan, Chen Shicai, Weng Yibing. Evaluation of voriconazole guided by CYP2C19 gene polymorphism in the treatment of patients with invasive fungal infection[J]. Journal of Capital Medical University, 2018, 39(3): 423-427.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2018.03.020

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2018/V39/I3/423

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