Résumé
Introduction: cyclosporine is the most used immunosuppressant therapy in post allograft stem cell transplantation on children and young adults. The nephrotoxicity is the main complication of cilosporin. The addition of azole antifungal prophylaxis interferes with the metabolism of cyclosporin, and decreases its elimination. Our objective is therefore to study the impact of the introduction of antifungal prophylaxis by azole drug on the serum dosage of cyclosporine and on its toxicities. Material and methods: we realized a monocentric retrospective observational study conducted at the University Hospital of Montpellier. We include all patients 1 to 25 years old admitted for an allogeneic HSCT from 2016 to 2021, and for whom introduction of azole treatment is done at least 7 days after initiation of cyclosporine immunosuppression. We recorded serum assay cyclosporine, the creatinine blood level and bold ionograms during the main stages of transplantation. Results: a total of 38 patients were included. Our data show a significant increase in serum cyclosporine concentration between 7 and 14 days after the introduction of fluconazole or Posaconazole prophylaxis (p<0.001). We observe a significant increase in serum creatinine levels 7 days after the introduction of azole prophylaxis (p<0.001). This increase remains significant at 30, 90 and 180 days despite a trend towards improvement (p<0.001). Conclusion: our study shows that the introduction of azole drugs has an impact on serum cyclosporine concentrations and its nephrotoxicity. It would be interesting to anticipate this variation by studying the pharmacokinetics of cyclosporin. To consider the important intra-and intra-individual variability of cyclosporin, the Bayesian model seems to be the most appropriate.