Background: Allergic bronchopulmonary Aspergillosis (ABPA) is an complex hypersensitivity reaction that occurs when bronchi become colonized with Aspergillus. ABPA occurs in approximately 10% of the CF patients. The mainstay of treatment is oral corticosteroid therapy for several months and is associated with significant adverse effects. Itraconazole in addition to glucocorticoids is of benefit to reduce steroid dosage. There is increasing evidence for the efficacy of the antifungal voriconazole. Methods: We reviewed the files of CF patients treated with voriconazole in our centre over the last 26 months. Results: Six patients (age 7y11m 24y10m median age 16y9m) received voriconazole as monotherapy for treatment of ABPA and/or invasive aspergillosis. In 2 patients voriconazole was started because of invasive aspergillosis secondary to steroid treatment for ABPA, in 4 patients because of severe side effects to previous ABPA treatment with corticoisteroids. Patients were treated for six months. All patients improved in pulmonary function and ABPA markers (eosinophilia, tot IgE, specific IgE). Up-to-date, after a follow-up of 2-20 months (median follow-up-period 6months) after the end of treatment in 5 patients , 1 patient relapsed 2 months after treatment, 4 patients showed sustained improvement in pulmonary function and ABPA markers and 1 patient is still on voriconazole treatment. Adverse effects occurred in 2 patients (photosensitivity skin reaction with in 1 of them transient visual disturbances). Conclusion: Our results confirm previous reports. Voriconazole monotherapy appears to be an alternative treatment strategy when oral corticosteroids are not suitable.
Full conference title:
20th European Respiratory Society conference
- ERS 20th (2010)