2018年04月26日 星期四

Leading International Fungal Education_April 2018

First RCT directly comparing itraconazole with prednisolone for acute ABPA
 
Guidelines have traditionally recommended glucocorticoids for first-line treatment of ABPA, but an RCT conducted in India (N=131) suggests itraconazole monotherapy could be a useful alternative to prednisolone, and has a lower burden of side effects. However, it is important to closely monitor patients treated with itraconazole as around 12% do not respond to this treatment.
 Allergic bronchopulmonary aspergillosis (ABPA) is an immune reaction against colonisation of the lungs by Aspergillus fumigatus. The global burden is thought to be around 5 million, with 1.4 million cases in India alone. Early diagnosis is essential to prevent progression to bronchiectasis and pulmonary fibrosis.
Dr Ritesh Agarwal and colleagues at PGIMER (Chandigarh, India) conducted an open-label randomised controlled trial comparing oral itraconazole (n=68) against prednisolone (n=63) as a first-line treatment in acute ABPA. All (100%) patients taking prednisolone achieved a treatment response, while 88% of patients on itraconazole did so; there were no obvious characteristics in common between non-responders. Itraconazole was not associated with many of the Cushingoid side effects that glucocorticoids are notorious for, although elevated ASTs/ALTs were seen in more itraconazole patients (15%) than prednisolone patients (0%).
Overall, these results suggest that itraconazole makes a good alternative for patients who cannot tolerate glucocorticoids (e.g. those with uncontrolled diabetes, obesity or osteoporosis), but treatment must be monitored as around 12% of patients will not respond.

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