Amphotericin B lipid complex for invasive fungal infections: analysis of safety and efficacy in 556 cases.
The safety and antifungal efficacy of amphotericin B lipid complex (ABLC) were evaluated in 556 cases of invasive fungal infection treated through an open-label, single-patient, emergency-use study of patients who were refractory to or intolerant of conventional antifungal therapy. All 556 treatment episodes were evaluable for safety. During the course of ABLC therapy, serum creatinine levels significantly decreased from baseline (P < .02). Among 162 patients with serum creatinine values > or = 2.5 mg/dL at the start of ABLC therapy (baseline), the mean serum creatinine value decreased significantly from the first week through the sixth week (P < or = .0003). Among the 291 mycologically confirmed cases evaluable for therapeutic response, there was a complete or partial response to ABLC in 167 (57%), including 42% (55) of 130 cases of aspergillosis, 67% (28) of 42 cases of disseminated candidiasis, 71% (17) of 24 cases of zygomycosis, and 82% (9) of 11 cases of fusariosis. Response rates varied according to the pattern of invasive fungal infection, underlying condition, and reason for enrollment (intolerance versus progressive infection). These findings support the use of ABLC in the treatment of invasive fungal infections in patients who are intolerant of or refractory to conventional antifungal therapy.
Walsh
T J
TJ
Infectious Diseases Section, National Cancer Institute, Bethesda, Maryland 20892, USA.
Hiemenz
J W
JW
Seibel
N L
NL
Perfect
J R
JR
Horwith
G
G
Lee
L
L
Silber
J L
JL
DiNubile
M J
MJ
Reboli
A
A
Bow
E
E
Lister
J
J
Anaissie
E J
EJ
D000328:Adult; D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy; D002177:Candidiasis / Q000188:drug therapy; D003404:Creatinine / Q000097:blood; D003453:Cryptococcosis / Q000188:drug therapy; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D009181:Mycoses / Q000188:drug therapy*; D010713:Phosphatidylcholines / Q000009:adverse effects / Q000627:therapeutic use*; D010715:Phosphatidylglycerols / Q000009:adverse effects / Q000627:therapeutic use*
D000935:Antifungal Agents; D004338:Drug Combinations; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B; D003404:Creatinine