Voriconazole trough concentration and clinical outcomes in patients with Talaromycosis

Abstract Background: Voriconazole (VRC) has been used as an alternative regimen for the treatment of talaromycosis. This study first analyzed the correlation between the VRC trough concentration and clinical outcomes. Methods: We prospectively enrolled patients diagnosed with talaromycosis who received VRC as induction therapy. Clinical information was collected for study analysis. Results: This study included 76 patients diagnosed with talaromycosis from October 2019 to June 2022. The results showed that 62 patients had clinical remission, and 5 patients died of talaromycosis. The overall effective rate of VRC was 89.9%. The incidence of treatment-related adverse events (AEs) was 17.4%, mainly including neurotoxicity and hypokalemia. The range of the initial VRC trough concentration was 0.23-16.95 μg/mL, indicating a large variability. No correlation was found between the VRC trough concentration and treatment failure. The mortality rate significantly increases when the patient's APSCHE II score > 10. The trough concentration threshold for AEs of VRC is 5.4 μg/mL. Conclusion: Voriconazole is an effective antifungal drug for the treatment of talaromycosis in patients with APACHE II scores < 10. Routine TDM may improve the management of treatment-related adverse events.