Impact of voriconazole/posaconazole on CsA in paediatric allogeneic haematopoietic stem cell transplantation recipients: A real-world study

104 pediatric allogeneic HSCT recipients, azoles (voriconazole/posaconazole) added to stable CsA treatment, DDI-CYP3A4 interaction quantification and evidence-based dose adjustment strategies

104 children receiving cyclosporine (CsA) in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) who simultaneously initiate an azole (voriconazole or posaconazole) are included in this real-world multicenter retrospective study. Azole co-administration causes a significant increase in CsA C/D ratio, related to CYP3A4/CYP3A5 inhibition. Clinical factors modulating the interaction (age, azole formulation) are identified, and practical dose adjustment recommendations are proposed for this frequent and clinically impactful CYP3A4 interaction in pediatric transplantation.

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

The azole-cyclosporine interaction is a highly clinically relevant interaction in pediatric oncology and transplantation: it can lead to CsA nephrotoxicity or underdosing if CsA is not adjusted. These real-world pediatric data fill a significant gap, as pediatric data on this interaction remain limited compared to adults.

Clinical impact: 2/3 · Evidence strength: 2/3 · Novelty: 1/2 · Sample size: 1/1 · Publication status: 1/1 → Total: 7/10