[Allergic bronchopulmonary aspergillosis: Evaluation of a maintenance therapy with nebulized Ambisome®].

Abstract

BACKGROUND:

Allergic bronchopulmonary aspergillosis (ABPA) affects 3-13% of patients with asthma. Its natural history includes possibly life-threatening exacerbations and evolution towards fixed obstructive ventilatory disorders or even irreversible lung fibrosis lesions. ABPA prognosis is directly associated with exacerbation control and the main objective of the treatment is to decrease their frequency and duration. Recommendations regarding dosage and duration of treatment are not very precise. The currently used combination of itraconazole and corticosteroid therapy has many limitations. The interests of a therapeutic strategy using nebulized liposomal amphotericin B (LAmB) are to heighten antifungal lung tissue concentration, to circumvent drug interactions and decrease the potential toxicity of systemic antifungal treatments. Finally, this association leads to improved eradication of Aspergillus, thereby limiting the risk of side effects and the emergence of treatment-resistant Aspergillus strains.

METHODS:

This is a phase II, multicentre, randomized, single blind, controlled therapeutic study, with the objective of comparing the potential benefit on exacerbation control of a maintenance therapy by LAmB nebulization. The main objective of the study is to compare the incidence of severe clinical exacerbations in ABPA treatment, between a maintenance treatment strategy with nebulized LAmB and a conventional strategy without antifungal maintenance therapy.

EXPECTED RESULTS:

The results will guide practitioners in the management of ABPA treatments and help to define the place of aerosols of LAmB on "evidence base medicine" criteria.

• Authors: C Godet, F Couturaud, S Ragot, F Laurent, A L Brun, A Bergeron, J Cadranel, groupe NEBULAMB
• Journal: Revue des maladies respiratoires (Rev Mal Respir) Vol. 34 Issue 5 Pg. 581-587 (May 2017) ISSN: 1776-2588 [Electronic] France
• Vernacular Title: Aspergillose bronchopulmonaire allergique : évaluation d’un traitement d’entretien par Ambisome®nébulisé.
• PMID: 28552257 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2017 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Chemical References

• Antifungal Agents
• liposomal amphotericin B
• Amphotericin B

Topics

• Administration, Inhalation
• Adolescent
• Adult
• Aged
• Amphotericin B (administration & dosage)
• Antifungal Agents (administration & dosage)
• Aspergillosis, Allergic Bronchopulmonary (drug therapy, pathology)
• Disease Progression
• Humans
• Maintenance Chemotherapy (methods)
• Middle Aged
• Nebulizers and Vaporizers
• Single-Blind Method
• Young Adult