Standard dosing regimen of liposomal amphotericin B is as effective as a high-loading dose for patients with invasive aspergillosis: AmBiLoad trial.
Invasive mold infections continue to account for significant morbidity and mortality in immunocompromised patients; outcomes are dependent on both underlying host factors and appropriate therapy. The antifungal armamentarium has gradually increased during the past, with liposomal amphotericin B (L-AMB) being an important representative. Still, the question of what dose to use - a maximum tolerated or a minimum effective - has yet to be answered. On this basis, a randomized trial comparing a high-loading dose regimen with a standard dosing of L-AMB (AmBiLoad trial) for primary therapy of mold infections was initiated. No significant differences in response between the treatment groups were detected, although recipients of the 10-mg/kg daily dose experienced higher rates of nephrotoxicity and hypokalemia. Uncontrolled malignancy and allogeneic stem cell transplantation were significantly associated with poor survival. This article analyzes the study, discusses the rationale and the results and concludes that this study supports the routine application of L-AMB.
Lass-Flörl
Cornelia
C
Innsbruck Medical University, Department of Hygiene, Microbiology and Social Medicine, Section of Hygiene and Medical Microbiology, Fritz Pregl Str. 3/III, 6020 Innsbruck, Austria. cornelia.lass-floerl@i-med.ac.at
D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D019337:Hematologic Neoplasms / Q000150:complications / Q000473:pathology; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced; D009404:Nephrotic Syndrome / Q000139:chemically induced; D009503:Neutropenia / Q000473:pathology; D015996:Survival Rate; D016896:Treatment Outcome
D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B