Efficacy of voriconazole in the treatment of pulmonary tuberculosis complicated with chronic pulmonary aspergillosis based on CYP2C19 gene polymorphism detection and the factors affecting the efficacy
10.16718/j.1009-7708.2025.02.003
- VernacularTitle:基于CYP2C19基因多态性检测指导伏立康唑治疗肺结核合并肺曲霉病的疗效及影响因素分析
- Author:
Yonggang CHEN
1
;
Mingli YU
;
Ji LUO
;
Wenlin ZHANG
;
Jintang HE
;
Qiqi XIAO
;
Junlong WANG
;
Jiangli PENG
Author Information
1. 昆明市第三人民医院药学部,昆明 650041
- Publication Type:Journal Article
- Keywords:
CYP2C19 gene polymorphism;
pulmonary tuberculosis;
pulmonary aspergillosis;
voriconazole;
treatment efficacy;
influencing factor
- From:
Chinese Journal of Infection and Chemotherapy
2025;25(2):132-139
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the efficacy of voriconazole in the treatment of pulmonary tuberculosis complicated with chronic pulmonary aspergillosis(CPA)based on CYP2C19 gene polymorphism detection and examine the factors affecting the efficacy for improving targeted therapy in clinical practice.Methods A total of 207 patients with pulmonary tuberculosis complicated with CPA treated in the Third People's Hospital of Kunming from December 2018 to November 2022 were randomly assigned to an observation group(105 cases)or a control group(102 cases).The patients in the control group received standard voriconazole treatment,while the patients in the observation group had their voriconazole regimen tailored based on CYP2C19 genotyping results.Plasma drug concentration levels,efficacy,and safety were compared between the two groups and in terms of CYP2C19 genotypes.Logistic regression analysis was used to identify the factors affecting treatment efficacy.Results The observation group showed significantly higher plasma voriconazole concentrations and overall antifungal efficacy compared to the control group(P＜0.05).In the observation group,CYP2C19 genotyping identified 37 extensive metabolizers(EM),47 intermediate metabolizers(IM),and 21 poor metabolizers(PM).Plasma concentration of voriconazole did not show significant difference between EM and IM(P＞0.05),but both PM and IM were associated with significantly lower plasma concentration of voriconazole than PM(P＜0.05).The clinical efficacy rate was 100％for PM,91.5％for IM,and 83.8％for EM(P＜0.05).The incidence of adverse events did not show significant difference among the three genotypes(P＞0.05).Logistic regression analysis revealed that lung cavitation,hypoalbuminemia,and agranulosis were significantly correlated with therapeutic efficacy(P＜0.05).Conclusions CYP2C19 gene polymorphism detection is valuable in clinical practice.It can inform anti-aspergillus therapy with voriconazole to effectively improve symptoms and clinical efficacy in patients with pulmonary tuberculosis complicated with CPA.Meanwhile,clinicians should be aware of the factors such as hypoproteinemia,agranulocytosis,and lung cavitation that may affect the efficacy of voriconazole.
