The Tolerability Of Amphotericin B Lipid Complex Formulation In Patients With Severe Infusion Reactions To Liposomal Amphotericin B

Ref ID: 18789

Author:

D. Farmakiotis, MD (Doctor of Medicine) – Infectious Diseases Fellow1, F. P. Tverdek, Pharm D – Clinical Pharmacist 2, D. Kontoyiannis, MD, FACP, FIDSA – Professor of Internal Medicine and Infectious Diseases 2;

Author address:

1Baylor Coll. of Med., MD Anderson Cancer Ctr., Houston, TX, 2MD Anderson Cancer Ctr., Houston, TX.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Amphotericin-B lipid formulations (Liposomal AMB-LAMB and AMB lipid complex-ABLC) are potent, broad-spectrum antifungal agents, but infusion-related reactions occasionally necessitate discontinuation of their administration. It is unclear whether infusion reactions represent a class effect, or if they are specific to each formulation. To that end, we sought to investigate the tolerability of ABLC by patients with a history of severe infusion reactions to LAMB, which, to our knowledge, has not been studied so far. Methods: We identified all patients with documented severe infusion reactions to LAMB, who received at least one dose of ABLC. Drug reactions were classified as doubtful, possible, probable and definite, using the Naranjo scale. Patients with doubtful reactions to L-AMB were excluded from analysis. Results: We identified 43 patients with a documented severe intolerance to L-AMB, who received at least one dose of ABLC. 10 patients were excluded, as documentation for severe intolerance to L-AMB was inaccurate. 12 (36 %) patients had probable, 20 (61 %) possible and 1 patient (3 %) had definite reactions to L-AMB. The most common reactions to L-AMB were dyspnea (45 %), myalgias (27 %), chest pain (21 %) and acute fever (12 %). Twenty-eight (85 %) patients with previous reactions to LAMB tolerated ABLC without any significant reactions. The remaining 5 patients experienced significant side effects (4 episodes of fever and chills, 2 of chest pain, 1 of lower back pain, 1 of confusion and 1 of tremors), leading to discontinuation of ABLC in all. No patient had a reaction that would require intubation or hemodynamic infusions. The median duration of treatment with ABLC was 10 (1-93) days. Importantly, 2 patients had a history of anaphylaxis after LAMB, but tolerated ABLC well. Conclusions: In our study, ABLC appeared to be safe in the majority (85 %) of patients with a history of severe intolerance to LAMB.

Abstract Number: M-1705

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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