2025 年 56 巻 6 号 p. 240-248
Background: Liver dysfunction is one factor that affects the pharmacokinetics of voriconazole (VRCZ). Evaluation of liver function may thus be useful for setting the initial VRCZ dosage. Recently, the albumin-bilirubin (ALBI) score has been developed as a new model to assess liver function in liver disease. We explored the association between ALBI score and the incidence of plasma VRCZ concentrations ≥ 4 µg/mL during VRCZ administration in patients treated for hematological malignancies.
Methods: We enrolled 79 patients (mean age, 67.8 years; 58 men) admitted to our hospital for treatment of hematological malignancies who received oral VRCZ loading doses. The following data were recorded: sex, age, weight, height, VRCZ maintenance dose per body weight, and laboratory data including plasma drug concentrations on day 4 after starting VRCZ administration. The primary outcome was the incidence of plasma drug concentrations ≥ 4 µg/mL on day 4 of VRCZ administration.
Results: Among 79 patients analyzed for VRCZ plasma concentrations, 43 (54.4%) had plasma drug concentrations ≥4 µg/mL on day 4 of VRCZ administration. The incidence of plasma drug concentration ≥ 4 µg/mL on day 4 of VRCZ administration was significantly higher in patients with an ALBI score ≥−2.27 (83.0%) than in patients with an ALBI score <−2.27 (12.5%; P < 0.001). Multivariate analysis revealed that ALBI score (odds ratio 56.716, 95% confidence interval 6.659-483.0; P < 0.001) was independently associated with the incidence of plasma drug concentrations ≥ 4 µg/mL on day 4 of VRCZ administration.
Conclusions: ALBI score was superior for distinguishing the occurrence of high plasma drug concentrations (≥ 4 µg/mL) early in treatment in patients receiving VRCZ loading dose therapy. ALBI score may offer a better indicator for determining a safe initial VRCZ dose for patients undergoing treatment for hematological malignancies.
