Intravenous Therapy for Chronic Pulmonary Aspergillosis: A Systematic Review and Meta-analysis

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dc.contributor.authorBongomin, Felix
dc.contributor.authorAsio, Lucy Grace
dc.contributor.authorOlum, Ronald
dc.contributor.authorDenning, David W.
dc.date.accessioned2023-01-22T17:53:17Z
dc.date.available2023-01-22T17:53:17Z
dc.date.issued2020
dc.description.abstractChronic 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.en_US
dc.identifier.citationBongomin, 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.13131en_US
dc.identifier.other10.1111/myc.13131
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7117
dc.language.isoenen_US
dc.publisherMycosesen_US
dc.subjectChronic pulmonary aspergillosisen_US
dc.subjectAmphotericinen_US
dc.subjectMicafunginen_US
dc.subjectCaspofunginen_US
dc.subjectAnidulafunginen_US
dc.subjectAspergillusen_US
dc.titleIntravenous Therapy for Chronic Pulmonary Aspergillosis: A Systematic Review and Meta-analysisen_US
dc.typeArticleen_US
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