The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report

Abstract Background Ganciclovir pharmacokinetics is characterized by a high variability in drug exposure. Usually, monitoring of ganciclovir exposure is performed by measuring trough concentration. However, due to the specificity of pediatric pharmacokinetics, trough concentration measurements may n...

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Autores principales:	Xavier Duval, Florian Lemaitre, Sophie Pertuisel, Jamie Probert, Virginie Gandemer, Marie-Clémence Verdier, Camille Tron
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Therapeutic drug monitoring Antiviral therapy Cytomegalovirus (CMV) Pharmacokinetics Hematopoietic stem cell transplantation Pediatrics Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/c2c38c165e1e4dc997811d146abc46b2
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spelling	oai:doaj.org-article:c2c38c165e1e4dc997811d146abc46b22021-11-14T12:44:08ZThe need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report10.1186/s12879-021-06828-81471-2334https://doaj.org/article/c2c38c165e1e4dc997811d146abc46b22021-11-01T00:00:00Zhttps://doi.org/10.1186/s12879-021-06828-8https://doaj.org/toc/1471-2334Abstract Background Ganciclovir pharmacokinetics is characterized by a high variability in drug exposure. Usually, monitoring of ganciclovir exposure is performed by measuring trough concentration. However, due to the specificity of pediatric pharmacokinetics, trough concentration measurements may not be a relevant surrogate of ganciclovir exposure. Area under the curve of concentration (AUC) may be a more appropriate biomarker. Case presentation We report the case of 3.6-year-old boy with Emberger syndrome with a cytomegalovirus reactivation occurring after allogenic hematopoietic stem cell transplantation. After a few days of treatment with intravenous ganciclovir, sub-therapeutic trough ganciclovir concentrations were measured (< 0.5 µg/mL) and viral load still increased. Ganciclovir dosage was increased by two-fold to deal with this treatment failure. Trough concentrations remained sub-therapeutic. The patient had hematologic disorder therefore it was decided to estimate ganciclovir AUC to assess more accurately drug exposure before any further dosage modification. AUC0–12 h was measured at 51 μg h/mL, which was within the therapeutic range (40–60 μg h/mL). Afterward, viral load decreased and became undetectable. Conclusions This case report highlights that monitoring ganciclovir exposure based on AUC should be performed to tailor drug dosage in order to improve treatment efficacy and safety in pediatric patients.Xavier DuvalFlorian LemaitreSophie PertuiselJamie ProbertVirginie GandemerMarie-Clémence VerdierCamille TronBMCarticleTherapeutic drug monitoringAntiviral therapyCytomegalovirus (CMV)PharmacokineticsHematopoietic stem cell transplantationPediatricsInfectious and parasitic diseasesRC109-216ENBMC Infectious Diseases, Vol 21, Iss 1, Pp 1-4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Therapeutic drug monitoring Antiviral therapy Cytomegalovirus (CMV) Pharmacokinetics Hematopoietic stem cell transplantation Pediatrics Infectious and parasitic diseases RC109-216
spellingShingle	Therapeutic drug monitoring Antiviral therapy Cytomegalovirus (CMV) Pharmacokinetics Hematopoietic stem cell transplantation Pediatrics Infectious and parasitic diseases RC109-216 Xavier Duval Florian Lemaitre Sophie Pertuisel Jamie Probert Virginie Gandemer Marie-Clémence Verdier Camille Tron The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report
description	Abstract Background Ganciclovir pharmacokinetics is characterized by a high variability in drug exposure. Usually, monitoring of ganciclovir exposure is performed by measuring trough concentration. However, due to the specificity of pediatric pharmacokinetics, trough concentration measurements may not be a relevant surrogate of ganciclovir exposure. Area under the curve of concentration (AUC) may be a more appropriate biomarker. Case presentation We report the case of 3.6-year-old boy with Emberger syndrome with a cytomegalovirus reactivation occurring after allogenic hematopoietic stem cell transplantation. After a few days of treatment with intravenous ganciclovir, sub-therapeutic trough ganciclovir concentrations were measured (< 0.5 µg/mL) and viral load still increased. Ganciclovir dosage was increased by two-fold to deal with this treatment failure. Trough concentrations remained sub-therapeutic. The patient had hematologic disorder therefore it was decided to estimate ganciclovir AUC to assess more accurately drug exposure before any further dosage modification. AUC0–12 h was measured at 51 μg h/mL, which was within the therapeutic range (40–60 μg h/mL). Afterward, viral load decreased and became undetectable. Conclusions This case report highlights that monitoring ganciclovir exposure based on AUC should be performed to tailor drug dosage in order to improve treatment efficacy and safety in pediatric patients.
format	article
author	Xavier Duval Florian Lemaitre Sophie Pertuisel Jamie Probert Virginie Gandemer Marie-Clémence Verdier Camille Tron
author_facet	Xavier Duval Florian Lemaitre Sophie Pertuisel Jamie Probert Virginie Gandemer Marie-Clémence Verdier Camille Tron
author_sort	Xavier Duval
title	The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report
title_short	The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report
title_full	The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report
title_fullStr	The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report
title_full_unstemmed	The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report
title_sort	need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/c2c38c165e1e4dc997811d146abc46b2
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The need for area under the curve measurements in the field of ganciclovir therapeutic drug monitoring in children: a case report

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