Voriconazole therapy and CYP2C19 phenotype: identifying patients who may need alternative antifungal therapy.

CYP2C19 phenotype-driven pharmacokinetic variability of voriconazole

In this multicentre retrospective study across three Australian hospitals (194 patients, 2019–2024), CYP2C19 phenotype was assessed post-hoc in patients who had received voriconazole without PGx results at the time of prescribing. Normal or intermediate metabolizers accounted for 69% of the cohort and ultrarapid/rapid metabolizers for 21%. The study analyzed the association between CYP2C19 status and switching to alternative antifungal therapy, confirming that lack of prior genotyping exposes a significant proportion of patients to underexposure or toxicity risk.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

This study illustrates the 'retrospective genotyping to validate preemptive utility' paradigm: recovering PGx status post-hoc demonstrates that CYP2C19 phenotype would have guided therapeutic decisions in a substantial number of cases. The multicenter, five-year design strengthens robustness. A direct argument for infectious disease and haematology units prescribing azoles empirically.

Clinical impact: 2/3 · Evidence strength: 2/3 · Novelty: 1/2 · Sample size: 1/1 · Journal quality: 0/1 → Total: 6/10