Echinocandin exposures in obese patients: A scoping review and clinical perspectives.

Yazed S Alsowaida, Ahmad Alamer, Abrar K Thabit, Abdulaziz S Almulhim, Muneerah M Aleissa, Alireza Kalbasi, Khaled Eljaaly, Thamer A Almangour, Brian L Erstad

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 2023 Apr 08

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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. 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 echinocandins exposures in obese patients. 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. © American Society of Health-System Pharmacists 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Citation

Yazed S Alsowaida, Ahmad Alamer, Abrar K Thabit, Abdulaziz S Almulhim, Muneerah M Aleissa, Alireza Kalbasi, Khaled Eljaaly, Thamer A Almangour, Brian L Erstad. Echinocandin exposures in obese patients: A scoping review and clinical perspectives. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2023 Apr 08;80(8):503-517