TY - JOUR
T1 - Echinocandin exposures in obese patients
T2 - A scoping review and clinical perspectives
AU - Alsowaida, Yazed S.
AU - Alamer, Ahmad
AU - Thabit, Abrar K.
AU - Almulhim, Abdulaziz S.
AU - Aleissa, Muneerah M.
AU - Kalbasi, Alireza
AU - Eljaaly, Khaled
AU - Almangour, Thamer A.
AU - Erstad, Brian L.
N1 - Publisher Copyright:
© American Society of Health-System Pharmacists 2023. All rights reserved.
PY - 2023/4/15
Y1 - 2023/4/15
N2 - Purpose: Echinocandins are favored drugs for the treatment of fungal infections. There is growing evidence that obese patients treated with echinocandins have lower exposures due to pharmacokinetic (PK) alterations. We conducted a scoping review to characterize, evaluate, and summarize the available evidence on echinocandins exposures in obese patients. Summary: A comprehensive search of PubMed, Embase, and Cochrane Library for studies on echinocandins published from database inception to October 28, 2022, was conducted using PRISMA-ScR methodology. A total of 25 studies comprising more than 3,174 subjects (8 micafungin studies, 7 caspofungin studies, 9 anidulafungin studies, and 1 rezafungin study) were included in this review. Seventeen studies reported lower echinocandins exposures in overweight and obese individuals compared with normal-weight individuals; the authors of these studies recommended dose adjustments. Conversely, 8 studies did not find significant differences in echinocandin exposure among subjects in varying body weight categories. Clinicians may consider dose adjustments of echinocandins in obese patients; however, there is limited evidence on the ideal dose adjustment strategy to overcome the low echinocandin exposures in obese patients. Conclusion: This scoping review shed light on a growing body of evidence indicating that obese patients have lower echinocandin exposures relative to targeted PK indices, which may lead to negative therapeutic implications. Currently, a lack of high-quality evidence impedes reaching consensus on recommendations for echinocandin dosing adjustment in obese patients. Future research evaluating the optimal echinocandin dosing strategy for obese patients is needed.
AB - Purpose: Echinocandins are favored drugs for the treatment of fungal infections. There is growing evidence that obese patients treated with echinocandins have lower exposures due to pharmacokinetic (PK) alterations. We conducted a scoping review to characterize, evaluate, and summarize the available evidence on echinocandins exposures in obese patients. Summary: A comprehensive search of PubMed, Embase, and Cochrane Library for studies on echinocandins published from database inception to October 28, 2022, was conducted using PRISMA-ScR methodology. A total of 25 studies comprising more than 3,174 subjects (8 micafungin studies, 7 caspofungin studies, 9 anidulafungin studies, and 1 rezafungin study) were included in this review. Seventeen studies reported lower echinocandins exposures in overweight and obese individuals compared with normal-weight individuals; the authors of these studies recommended dose adjustments. Conversely, 8 studies did not find significant differences in echinocandin exposure among subjects in varying body weight categories. Clinicians may consider dose adjustments of echinocandins in obese patients; however, there is limited evidence on the ideal dose adjustment strategy to overcome the low echinocandin exposures in obese patients. Conclusion: This scoping review shed light on a growing body of evidence indicating that obese patients have lower echinocandin exposures relative to targeted PK indices, which may lead to negative therapeutic implications. Currently, a lack of high-quality evidence impedes reaching consensus on recommendations for echinocandin dosing adjustment in obese patients. Future research evaluating the optimal echinocandin dosing strategy for obese patients is needed.
KW - anidulafungin
KW - caspofungin
KW - echinocandins
KW - micafungin
KW - obesity
KW - rezafungin
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U2 - 10.1093/ajhp/zxad021
DO - 10.1093/ajhp/zxad021
M3 - Article
C2 - 36680786
AN - SCOPUS:85152164972
SN - 1079-2082
VL - 80
SP - 503
EP - 517
JO - American Journal of Health-System Pharmacy
JF - American Journal of Health-System Pharmacy
IS - 8
ER -