title: Pharmacokinetics and safety of voriconazole intravenous-to-oral switch regimens in immunocompromised Japanese pediatric patients.
abstract: The aim of this study was to investigate the pharmacokinetics, safety, and tolerability of voriconazole following intravenous-to-oral switch regimens used with immunocompromised Japanese pediatric subjects (age 2 to <15 years) at high risk for systemic fungal infection. Twenty-one patients received intravenous-to-oral switch regimens based on a recent population pharmacokinetic modeling; they were given 9 mg/kg of body weight followed by 8 mg/kg of intravenous (i.v.) voriconazole every 12 h (q12h), and 9 mg/kg (maximum, 350 mg) of oral voriconazole q12h (for patients age 2 to <12 or 12 to <15 years and <50 kg) or 6 mg/kg followed by 4 mg/kg of i.v. voriconazole q12h and 200 mg of oral voriconazole q12h (for patients age 12 to <15 years and ≥50 kg). The steady-state area under the curve over the 12-h dosing interval (AUC0-12,ss) was calculated using the noncompartmental method and compared with the predicted exposures in Western pediatric subjects based on the abovementioned modeling. The geometric mean (coefficient of variation) AUC0-12,ss values for the intravenous and oral regimens were 51.1 μg · h/ml (68%) and 45.8 μg·h/ml (90%), respectively; there was a high correlation between AUC0-12,ss and trough concentration. Although the average exposures were higher in the Japanese patients than those in the Western pediatric subjects, the overall voriconazole exposures were comparable between these two groups due to large interindividual variability. The exposures in the 2 cytochrome P450 2C19 poor metabolizers were among the highest. Voriconazole was well tolerated. The most common treatment-related adverse events were photophobia and abnormal hepatic function. These recommended doses derived from the modeling appear to be appropriate for Japanese pediatric patients, showing no additional safety risks compared to those with adult patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT01383993.).
authors.affiliation: Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan mmori@med.yokohama-cu.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kobayashi
authors.affiliation: Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Maeda
authors.affiliation: Department of Pediatrics, Dokkyo Medical University School of Medicine, Tochigi, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Fukushima
authors.affiliation: Department of Hematology and Regenerative Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Goto
authors.affiliation: Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Clinical Pharmacology, Clinical Research, Pfizer Japan, Inc., Tokyo, Japan.
authors.forename: Chieko
authors.initials: C
authors.lastname: Muto
authors.affiliation: Clinical Statistics, Development Operations, Pfizer Japan, Inc., Tokyo, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Okayama
authors.affiliation: Infectious Disease, Clinical Research, Pfizer Japan, Inc., Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Clinical Pharmacology, Global Established Pharma Business, Pfizer, Inc., Groton, Connecticut, USA.
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007275:Injections, Intravenous; D008297:Male; D065819:Voriconazole / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole