Hepatic dysfunction events associated with voriconazole: a real-world
study from FDA adverse event reporting system (FAERS) database
Abstract
Aims: Although voriconazole-induced hepatotoxicity has been reported
previously, the direct cause-effect relationship in the real world
remains to be established. The aim of this study was to investigate the
association between voriconazole and hepatic dysfunction based on the
FAERS database. Methods: Data from January 2004 to March 2022 in FAERS
were retrieved. We estimate the association between the hepatic
dysfunction and voriconazole using reporting odds ratios (RORs) for
mining the adverse event report signals and compare voriconazole with
the full database and other antifungal drugs. Results: 646 reports of
hepatic dysfunction related to voriconazole as the primary suspect drug
were collected totally. The median time to event of the hepatic
dysfunction events was 8 (interquartile range [IQR] 2-28) days.
62.20% hepatic-related adverse events appeared within the first 15 days
since the initiation of voriconazole administration. The overall ROR
(95% CI) for hepatic-related adverse events was 6.82 (95% CI
6.26-7.42). Comparing to other antifungal drugs, the RORs for
hepatic-related adverse events of fluconazole, isavuconazole and
amphotericin B were 2.19 (95% CI 1.94-2.47), 2.31 (95% CI 1.66-3.33)
and 1.26 (95% CI 1.08-1.48), respectively. Conclusions: We observed
strong signals of higher frequency of reporting hepatic dysfunction
events associated with voriconazole in the events of hepatic
dysfunction. Since the risk of developing liver injury and possible
hepatic dysfunction by voriconazole depends on several factors including
underlying hepatic disease, close clinical and laboratory monitoring,
including therapeutic drug monitoring (TDM), are essential to prevent or
promptly recognize further deterioration of the hepatic function.