Intravenous Therapy for Chronic Pulmonary Aspergillosis: A Systematic Review and Meta-analysis
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Mycoses
Abstract
Chronic pulmonary aspergillosis (CPA) is a potentially life-threatening debilitating lung
disease necessitating long-term oral antifungal treatment. However, development of
antifungal resistant isolates of Aspergillus and major toxicities requiring discontinuation of
treatment limit their use. Intravenous (IV) antifungals are an option in this group of
patients. We comprehensively evaluate the response rates to IV antifungals in the
management of CPA. We searched Medline and Embase databases to select clinical
studies providing information about IV amphotericin B or an echinocandin for the
treatment of CPA from inception to May 2020. Reviews, single case reports and case
series reporting less than 10 patients were excluded. We evaluated 12 eligible studies. A
total of 380 patients received amphotericin B (n =143) or an echinocandin (n=237) and
were included in the meta-analysis. In a pooled analysis, overall response to IV
antifungals was 61% ((95% confidence interval (CI): 52-70%; I2=73.3%; p<0.001), to
amphotericin B was 58% (95% CI: 36-80%; I2=86.6%; p<0.001) and to echinocandins
was 62% (95% CI: 53-72%; I2=63.6%; p<0.001). Amphotericin B courses were usually
doses at slightly less that 1mg/Kg (deoxycholate) or 3mg/Kg (liposomal) for 2-3 weeks.
Micafungin doses varied from 12.5 to 300mg (frequently, 150mg) daily for at least 3
weeks, and sometimes much longer. Liposomal amphotericin B was well tolerated, but
led to renal function loss in 25% of patients. Adverse events were observed in 5 – 35.3%
of patients receiving echinocandins, none of which was considered major. Intravenous
antifungals have a place in the management of CPA. A head-to-head comparison of
amphotericin B and echinocandins is lacking, and future studies should look at evaluating
short and longer-term outcomes of these agents.
Description
Keywords
Chronic pulmonary aspergillosis, Amphotericin, Micafungin, Caspofungin, Anidulafungin, Aspergillus
Citation
Bongomin, F., Asio, L. G., Olum, R., & Denning, D. W. (2020). Intravenous therapy for chronic pulmonary aspergillosis: A systematic review and meta‐analysis. Mycoses, 63(9), 921-927. doi: 10.1111/myc.13131