{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:25:36Z","timestamp":1786940736166,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n The use of letermovir for cytomegalovirus prophylaxis in lung transplant recipients is increasing. Letermovir may reduce voriconazole exposure through induction of CYP\u2010mediated metabolism. This study compared voriconazole concentrations in lung transplant recipients with and without concomitant letermovir exposure.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This single\u2010center retrospective study evaluated lung transplant recipients on prophylactic voriconazole, stratified by letermovir use. Exclusion criteria included non\u2010steady state concentrations, concomitant interacting medications, and extracorporeal membrane oxygenation. The primary outcome was achievement of first voriconazole concentrations meeting lower and higher target thresholds (\u2265 0.5 and \u2265 1 mcg\/mL). Secondary outcomes included concentration\u2010to\u2010dose (mg\/kg\/day) ratio and median first concentration (mcg\/mL).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Twenty\u2010four patients receiving voriconazole alone contributed 46 concentrations, while 14 patients receiving concomitant letermovir contributed 30 concentrations. Fewer patients in the concomitant group achieved first voriconazole concentrations \u2265 0.5 mcg\/mL (23.3%\u00a0vs. 34.8%, p = 0.29) and \u2265 1 mcg\/mL (3.3%\u00a0vs. 21.7%, p = 0.042). The concentration\u2010to\u2010dose ratio (0.174\u00a0vs. 0.266 L\/kg, p = 0.16) and median first concentration (0.52\u00a0vs. 0.72 mcg\/mL, p = 0.19) were also lower with concomitant therapy. One definite breakthrough fungal infection occurred in the concomitant group (3.3%) compared with two probable infections in the voriconazole\u2010only group (4.3%). Breakthrough CMV viremia occurred in 14.3% and 16.7% of patients, respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n This is the first study evaluating the impact of concomitant letermovir on voriconazole exposure during the early posttransplant period in lung transplant recipients. Concomitant letermovir was associated with reduced attainment of target voriconazole concentrations, supporting routine therapeutic drug monitoring and consideration of empiric voriconazole dose escalation when these agents are co\u2010administered.\n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/tid.70307","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:06:54Z","timestamp":1786939614000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Letermovir on Voriconazole Concentrations in Lung Transplant Patients"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2785-939X","authenticated-orcid":false,"given":"Leah","family":"Georgiades","sequence":"first","affiliation":[{"name":"Department of Pharmacy University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunish","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin K.","family":"McCreary","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda","family":"Silveira","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raman","family":"Venkataramanan","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences School of Pharmacy University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vignesh","family":"Vasudevan","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences School of Pharmacy University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0631-1358","authenticated-orcid":false,"given":"Ryan M.","family":"Rivosecchi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.14279"},{"issue":"3","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1093\/cid\/ciaa652","article-title":"Isavuconazole Is as Effective as and Better Tolerated Than Voriconazole for Antifungal Prophylaxis in Lung Transplant Recipients","volume":"73","author":"Samanta P.","year":"2021","journal-title":"Clinical Infectious Diseases"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd\u20102021\u201026"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw326"},{"key":"e_1_2_10_6_1","unstructured":"PREVYMIS (Letermovir) \u201cPackage Insert \u201d (fizer Inc.;2017) Revised February 2026."},{"key":"e_1_2_10_7_1","unstructured":"VFEND (voriconazole) \u201cPackage Insert \u201d (Pfizer Inc. 2010) Revised February 2026."},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185\u2010021\u201003105\u2010x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/prp2.1120"},{"issue":"11","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.30608","article-title":"Letermovir for Cytomegalovirus Prophylaxis in Pediatric Hematopoietic Stem Cell Transplantation","volume":"70","author":"Chen T. T.","year":"2023","journal-title":"Pediatric Blood & Cancer"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/bcp.70501"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1704863"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14217581"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010020\u201003397\u20101"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02808\u201013"},{"issue":"5","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1128\/AAC.05219-11","article-title":"Prospective, Observational Study of Voriconazole Therapeutic Drug Monitoring Among Lung Transplant Recipients Receiving Prophylaxis: Factors Impacting Levels and Associations Between Serum Troughs, Efficacy, and Toxicity","volume":"56","author":"Mitsani D.","year":"2012","journal-title":"Antimicrobial Agents and Chemotherapy"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkw045"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.14337"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2025.04.014"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00060014"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00504\u201010"}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.70307","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tid.70307","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.70307","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:06:56Z","timestamp":1786939616000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.70307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,16]]},"references-count":20,"alternative-id":["10.1111\/tid.70307"],"URL":"https:\/\/doi.org\/10.1111\/tid.70307","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"value":"1398-2273","type":"print"},{"value":"1399-3062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,16]]},"assertion":[{"value":"2026-04-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70307"}}