Antifungal drugs Committee
Antifungal Drugs Committee
Chair: Eliane M Billaud (eliane.billaud@egp.aphp.fr)
Vice chair: Jan-Willem Alffenaar (j.w.c.alffenaar@apoth.umcg.nl)
a. Background/Purpose of the Committee
The Special Interest Group on Antifungal Drugs TDM, announced in 2006 has been changed into the Antifungal Drugs Committee by the end of 2007 after the last IATDMCT Congress in Nice.
Invasive fungi infections (aspergillosis, candidosis) are an emerging problem, associated to a very high mortality rate ranging from 30 to 80% depending upon the severity of the immuno-depression and the underlying host disease (transplantation, AIDS, cancer...).
After a long period with a limited panel of active drugs, several improvements have recently been made in the arsenal of antifungal drugs (lipid formulation of Amphotericine B, new azoles as well as the new class echinocandins).
Several fields are concerned by the coverage of these pathologies, exhibiting a bad prognostic in complex clinical situations: infections pathologists, mycologists, haematologists, immunologists, transplant physicians and ... pharmacologists
There is an emerging evidence for Antifungals TDM, specially azole drugs, but several questions remain a matter of debate, resulting in several perspectives for the Antifungal Drug Committee.
TDM and pharmacokinetics are likely to improve the preservation of efficacy as well as provide a safe use of these very costly drugs, regarding drug drug interactions and switch between routes of administration (PO/IV) as well as antifungal strategies choice including antifungal combinations.
The objectives of this group were to deal with evaluating the knowledge of clinical pharmacology and defining the potential issues of TDM of these drugs.
b. Committee Membership List
Regular members have joined the Committee
Jan-Willem ALFFENAAR (Groningen, NL)
Roger BRUGGEMANN (Nijmegen, NL)
William HOPE (Manchester, UK)
Shahid HUSAIN (Toronto, CN)
Occasional correspondents are also concerned
Daan TOUW (NL)
David ANDES (Madison, WI, US)
Thierry GOUGNARD (Liège, BE)
New members have joined in Montreal
Michelle MORETON (London, UK)
Delphine ALLORGE (Lille, FR)
M CUSATO (Pavia, IT)
M REGAZZI (Pavia, IT)
Barbara VADNAIS (Montréal, CN) (young scientist)
X (Bruxelles, BE) : waiting for a correspondent from Pierre WALLEMAQ team
c. Minutes of Committee Meeting at the Montreal IATDMCT Congress
Attendance : JCW Alffenaar (NL), M Moreton (UK), D Allorge (FR), M Cusato (IT), M Regazzi(IT), EM Billaud (FR)
Members presentation roundtable.
New members from Italy, UK and France was considered as an important perspective to add new centres and develop a larger area of countries representation in the Committee, as well as different specialised topics (analytics, pharmacology, clinics)
Presentation of the Committee Report for the 16th Annual General Meeting
Ongoing
- Proficiency testing scheme (KKGT)
The external quality control KKGT organised by NL (D. Touw, D Burger, R Brüggemann) for azole drugs [fluconazole (FCZ), itraconazole and its metabolite (ITZ and OH-ITZ), voriconazole (VRZ) and posaconazole (PSZ)] is now available on behalf the IATDMCT and provides 2 runs per year since 2008.
Contact : R.Bruggemann@akf.umcn.nl
info@kkgt.nl
We discussed the opportunity of some suggestions regarding data presentation and analysis listed from the Bioanalytics IS IPTS or Probioqual
Some rules have to be implemented to score blanks samples. A possibility to include collaborations between other domestic External Quality Schemes has to be discussed (France : Asqualab, contact Catherine Palette via EM Billaud; UK : John Wilson via D Touw)
- collaborative study POSAVAR on PSZ variability
A collaborative study on posaconazole variability is ongoing in some centres; The study design is currently available
Contact eliane.billaud@egp.aphp.fr
- educational
1. Recommendations on azole AF TDM
There are several reviews already available on azole TDM, most of them from the Infectious Diseases side. The aim of the Committee is to provide specific recommendations on behalf the IATDMCT
2. Promotion of AF TDM
There is an important work to be done to provide AF TDM in fields that are not necessarily used to TDM and to meet with pharmacoeconomics criteria
3. Two workshops have been successfully attended in Nice and Montreal, designed to make an update on pharmacokinetic specifications as well as infectious and clinical endpoints supporting regular TDM of antifungal drugs, specially the recent voriconazole and posaconazole, in order to propose appropriate parameters, therapeutic target ranges and frequency of follow-up,
to identify situations at risk and to make some proposal for the management of these treatments and their coprescriptions, specially in case of CYP3A4 or Pgp substrates.
Perspectives
- There is an important link between IATDMCT Committee on AF and Infectious disease area and colleagues, in different clinical settings, to be continued (S Husain in SOT, W Hope...)
- We would like to justify a dedicated oral session in the next IATDMCT Congress issue in Stuttgart, meaning a sufficient number of abstracts)
- develop collaborative prospective studies to answer some of the questions addressed in recent review papers (D Andes)
- There is a need for collaborative joint analysis to compare special populations (ie Cystic fibrosis, transplanted or not, young adults versus paediatrics)
- register a bank of case report
d. a list of Committee initiatives for 2010 (IATDMCT Executive and Council stress the importance of Scientific Committees maintaining their activity level
Perspectives have been discussed during the last meeting in Montreal and are focused on
- IPTS (number of issues, analysis, presentation, collaboration between national programs)
- recommendations for AF TDM on behalf the IATDMCT
- collaborative studies
- increasing participants as member of a network
- welcome young colleagues in our centres
- promote AF TDM inside (website update) and outside the IATDMCT (Infectious disease and specific clinical backgrounds)
