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Topline:

Nebulized amphotericin B does not improve exacerbation-free status at 1 year for patients with bronchopulmonary aspergillosis, though it may delay onset and incidence.

Methodology:

  • Investigators searched PubMed and Embase databases for studies that included at least five patients with allergic bronchopulmonary aspergillosis who were managed with nebulized amphotericin B.

  • They included five studies, two of which were randomized controlled trials (RCTs), and three were observational studies; there was a total of 188 patients.

  • The primary objective of this systematic review and meta-analysis was to determine the frequency of patients remaining exacerbation free 1 year after initiating treatment with nebulized amphotericin B.

Takeaway:

  • From the studies (one observational, two RCTs; n = 84) with exacerbation data at 1 or 2 years, the pooled proportion of patients who remained exacerbation free with nebulized amphotericin B at 1 year was 76% (I2 = 64.6%).

  • The pooled difference in risk with the two RCTs that assessed exacerbation-free status at 1 year was 0.33 and was not significantly different between the nebulized amphotericin B and control arms, which received nebulized saline.

  • Two RCTs provided the time to first exacerbation, which was significantly longer with nebulized amphotericin B than with nebulized saline (337 vs 177 days; P = .004; I2 = 82%).

  • The proportion of patients who experienced two or more exacerbations was significantly lower with nebulized amphotericin B than with nebulized saline (9/33 [27.3%] vs 20/38 [52.6%]; P = .03).

In Practice:

“The time to first exacerbation was prolonged with NAB [nebulized amphotericin B]therapy and is an important indicator of effectiveness. Also, the proportion of subjects experiencing ≥2 exacerbation was also lesser with NAB than in the control, cipro antibiotico infecção urinaria ” concluded Valliappan Muthu, MD, and colleagues. However, “the ideal duration and optimal dose of LAMB for nebulization are unclear.”

Study Details

“Nebulized Amphotericin B for Preventing Exacerbations in Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Meta-Analysis” was published online in Pulmonary Pharmacology and Therapeutics in May 2023.

Limitations

The current review is limited by the small number of included trials and may have a high risk of bias. Therefore, more evidence is required for the use of nebulized amphotericin B in routine care. The authors have disclosed no conflicts of interest.

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