Clinical utility of pharmacogenomic testing for patients with coccidioidal meningitis

Med Mycol. 2024 Dec 5;62(12):myae113. doi: 10.1093/mmy/myae113.

Abstract

Coccidioidomycosis can cause severe meningitis, requiring lifelong treatment. In this study, we sought to better understand the potential effect of pharmacogenomic testing on treatment outcomes of patients with coccidioidal meningitis. Of 13 patients with coccidioidal meningitis who underwent pharmacogenomic testing, 11 had genetic variants of CYP2C19 and CYP3A5 that affect antifungal efficacy. These results led to real-time treatment changes and future antifungal planning. Routine pharmacogenomic testing helps to avoid antifungal treatments that are futile or lead to adverse effects.

Keywords: antifungal treatment; coccidioidal meningitis; coccidioidomycosis; pharmacogenomics.

Plain language summary

Pharmacogenomic testing is used for assessing genetic variation to predict a patient’s response to medications. Our findings from 11 of 13 patients with coccidioidal meningitis revealed genetic variants affecting therapeutic concentrations of medication used for treating coccidioidal meningitis.

MeSH terms

  • Adult
  • Aged
  • Antifungal Agents* / pharmacology
  • Antifungal Agents* / therapeutic use
  • Coccidioidomycosis* / diagnosis
  • Coccidioidomycosis* / drug therapy
  • Coccidioidomycosis* / microbiology
  • Cytochrome P-450 CYP2C19 / genetics
  • Female
  • Humans
  • Male
  • Meningitis, Fungal* / diagnosis
  • Meningitis, Fungal* / drug therapy
  • Meningitis, Fungal* / microbiology
  • Middle Aged
  • Pharmacogenomic Testing* / methods
  • Treatment Outcome
  • Young Adult

Substances

  • Antifungal Agents
  • Cytochrome P-450 CYP2C19
  • CYP2C19 protein, human

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