The clinical response to a short-term course of intravenous liposomal amphotericin B therapy in patients with chronic pulmonary aspergillosis

Ref ID: 19442

Author:

P. Newton, C. Harris and D. W. Denning

Author address:

The National Aspergillosis Centre, Manchester, United Kingdom

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Objective This audit was performed to assess whether patients with
chronic pulmonary aspergillosis (CPA) experience a sustained clinical
benefit from a short course (< 6 weeks) of intravenous liposomal amphotericin B therapy (LAmB). Methods CPA patients who had received their first short-course of intravenous LAmB therapy (Gilead) at the National Aspergillosis Cen- tre in Manchester were identified. A retrospective patient case-note review was performed using a standardised proforma. Data collected included patient demographics, indication for LAmB treatment, the dose and duration of therapy and the clinical response to treatment. Patients who received <3 doses of LAmB were not evaluated for response (n = 2). Results 48 CPA patients (23 females, 25 males) were identified aged 28-86 years (median 64) when treated. The median duration of prior azole therapy was 11.5 months (range 0-51 months). The dose and duration of intravenous LAmB given ranged between 2.47-5 (mean 3.03) mg/Kg daily and 1-36 (mean 16.9) days respectively. 1 patient was unable to tolerate the test dose of LAmB and received no further treatment. The primary reason for therapy was either respira- tory (48%) or both respiratory and constitutional symptoms (52%). The average number of respiratory and constitutional symptoms per patient was 4.5 (range 1-7) symptoms. 15 of 47 (32%) patients developed an acute kidney injury whilst on LAmB therapy resulting in the need for IV rehydration; 3 with other contributing factors to their renal impairment. 5 patients needed to stop their LAmB treatment early, two of whom had received a LAmB dose reduction. 4 other patients successfully com- pleted their LAmB course following dose reduction. 30 of 46 (65%) patients experienced a clinical response to LAmB therapy. Improvements in respiratory and constitutional symptoms were seen in 27 (58.6%) and 19 patients (41.3%) respectively. 27 (90%) out of 30 patients who completed the St George’s Respiratory Questionnaire (SGRQ) Quality of Life Score pre and post treatment noticed an improvement in a least one modality with 18 (60%), 16 (53.3%), 12 (40%) and 15 (50%) patients experiencing an improve- ment in their symptom, impact, activity and total scores respectively. Response was usually delayed and only apparent at follow up post- discharge. Improvement in the immunological markers of Aspergillus infection were observed in 9 (26.4%) out of the 34 patients who had adequate immunological data available. 13 patients had Aspergillus PCR per- formed on their sputum prior to LAmB treatment and 10 had a posi- tive PCR result. Following treatment the Aspergillus PCR in sputum became negative in 7 patients. Conclusion 65% of CPA patients receiving their first course of LAmB treatment experienced a clinical response. Improvements in respiratory and constitutional symptoms were seen in 58.6% and 41.3% of patients respectively. An acute kidney injury was observed in 32.6% of patients receiving LAmB therapy with 5 (10.9%) patients needed to stop their treatment course early. Routine intrave- nous rehydration at initiation of LAmB therapy and avoidance of other factors that may contribute to an acute kidney injury should be considered in all patients receiving LAmB therapy.

Abstract Number: p384

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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