Background: Invasive aspergillosis remains a disease with significant morbidity. Reported response rates with conventional amphotericin B range from 10-30% with effective therapy limited by nephrotoxicity, drug penetration, and side effects. Until the development of the lipid-complexed amphotericin agents, alternative therapeutic options for invasive aspergillosis were limited. ABLC has demonstrated reduced nephrotoxicity and efficacy in earlier randomized trials in patients with fungal infections; prior published data for possible utility in refractory aspergillosis have been limited. Methods: Since the commercial availability of ABLC, an international registry database (the CLEAR program) has been maintained to retrieve information on hospitalized patients treated with ABLC. This database encompasses: underlying disease, dosing and duration of ABLC therapy, causative pathogen(s), diagnostic method, prior antifungal medication(s), concomitant medication(s), renal assessment, and mycologic and clinical outcomes at the completion of therapy or at hospital discharge. This database was reviewed to identify all patients with a confirmed diagnosis of invasive aspergillosis who initiated ABLC therapy following failure of prior antifungal therapy. Results: Of 292 patients with invasive aspergillosis, 122 patients were identified with refractory infection, defined as the failure to achieve stabilization or improvement with conventional antifungal therapy (primarily amphotericin). Among the 122 patients refractory to other antifungal therapy and subsequently treated with ABLC, 65/122 (54%) responded to ABLC with a median treatment duration 17 days. Response rate by site(s) of infection included: lung 47/92 (51%), sinus 12/21 (57%), and central nervous system 4/11 (36%). ABLC did not provoke nephrotoxicity. The median pretreatment creatinine was 1.2 mg/dl and end-of-therapy creatinine was 1.6 mg/dl. Summary: The use of lipid-complexed amphotericin (ABLC) in invasive aspergillosis may be efficacious in patients who have not responded to other antifungal therapy
Full conference title:
37th Annual Meeting of the Infectious Diseases Society of America (IDSA), November 18-21.
- IDSA 37th