The effects of triazole antifungal agents on cyclosporine during intensive immunosuppressive therapy for severe aplastic anemia
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摘要: 目的:评价重型再生障碍性贫血(SAA)患者采用强化免疫抑制治疗过程中,三唑类预防性抗真菌药物泊沙康唑和伊曲康唑对环孢素(CsA)的影响。方法:SAA患者接受抗胸腺细胞免疫球蛋白和CsA治疗,分别给予泊沙康唑或伊曲康唑口服,预防真菌感染,分析不同抗真菌药物对CsA的血药浓度影响及药物剂量调整情况,比较其不良反应及医疗费用。结果:共入组55例SAA患者,分为泊沙康唑组(POSA组)(31例)和伊曲康唑组(ITRAC组)(24例),2组患者的临床特征具有可比性。POSA组和ITRAC组分别有54.8%和66.7%的患者需要降低CsA药物剂量,ITRAC组CsA维持剂量明显低于POSA组(P＜0.01),肝损害发生率明显高于POSA组(70.8%vs 38.7%,P=0.018)。结论:泊沙康唑和伊曲康唑与CsA有明显相互作用,在SAA强化免疫抑制治疗中,CsA的剂量应根据合并用药的类型减量,联用泊沙康唑肝损害发生率低于联用伊曲康唑。Abstract: Objective:To evaluate the effects of posaconazole(POSA) and itraconazole(ITRAC) on cyclosporine A(CsA) in patients with severe aplastic anemia(SAA) undergoing intensive immunosuppressive therapy in the real world.Method:A total of 55 SAA patients who received anti-thymocyte immunoglobulin and CsA were enrolled and assigned to the POSA group(31 patients) or the ITRAC group(24 patients).The plasma concentration and dose adjustment of CsA were analyzed.The side effects and medical expenses of both groups were retrospectively compared.Result:Patients' characteristics were comparable in both groups.54.8% of the patients in the POSA and 66.7% in the ITRAC group required CsA dose reduction.The maintenance dose of CsA was significantly lower than initial dose in the POSA group(P＜0.01),and the incidence of liver impairment was significantly higher in the ITRAC group(70.8% vs 38.7%,P=0.018).Conclusion:POSA and ITRAC have obvious interaction with CsA.The dose of CsA should be reduced depending on the choice of combined medication.CsA combined with POSA had a more favourable liver safety profile than with ITRAC.
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Key words:
- severe aplastic anemia /
- posaconazole /
- itraconazole /
- cyclosporine A /
- drug interactions
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