Posaconazole has better therapeutic efficacy in comparison with itraconazole and voriconazole in ABPA amongst Cystic Fibrosis patients

The hypersensitive response to Aspergillus species in ABPA patients results in inflammation and airway destruction resulting in bronchiectasis. Cystic fibrosis (CF) patients are at risk of ABPA which can speed up lung function decline. The current ‘gold standard’ treatment is prednisolone to reduce inflammation but azoles have been used effectively as steroid alternatives but have various side effects and tolerance issues.

In this paper the authors sought to discover if posaconazole, which is known to be less toxic and better absorbed than other azoles, was more effective at treating ABPA.

Using a retrospective analysis of 596 CF patients, the authors reviewed specific Aspergillus IgE levels and azole levels in blood samples. 32 patients were identified and included in the analysis. 11 had itraconazole alone, 12 had two different azoles and 9 received all three azoles. In total, 30 received itraconazole, 13 received voriconazole, 18 received posaconazole.

The authors also found IgE levels to be significantly reduced when posaconazole was used, but not the other azoles, suggesting that monitoring posaconazole levels and altering the dose given to the patient to attain greater serum levels gives improved serology in ABPA patients.