title: Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B: a review and meta-analysis.
abstract: Lipid preparations of amphotericin B, commonly used to treat fungal infections, have been demonstrated to have reduced nephrotoxicity compared to conventional amphotericin B. However, to our knowledge, a comprehensive comparison of nephrotoxicity induced by different lipid preparations of amphotericin B has not been performed. We conducted a meta-analysis to evaluate nephrotoxicity associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AmB). We searched the PubMed MEDLINE database and abstracts presented at key scientific meetings, and identified 11 studies reported between 1995 and 2008 that compared nephrotoxicity resulting from the use of these agents. Eight of the 11 studies were included in the meta-analysis. The Cochran-Mantel-Haenszel test was used to determine odds ratio (OR) and relative risk (RR), and the Breslow-Day test was used to analyze homogeneity of ORs across different studies. Analysis of all 8 studies (n = 1160) included in the meta-analysis showed an increased probability of nephrotoxicity in patients treated with ABLC versus L-AmB (OR, 1.75; RR, 1.55), but there was a significant lack of homogeneity across these studies (p < 0.001). After excluding the study by Wingard et al, the probability of experiencing nephrotoxicity was more similar between the 2 AmB lipid preparations (OR, 1.31; RR, 1.24; n = 916), particularly when the analysis included only the salvage patient population reported by Hachem et al (OR, 1.12; RR, 1.09; n = 839); the 7 remaining studies were more homogenous by Breslow-Day test (p = 0.054). Our results suggest that nephrotoxicity is generally similar for ABLC and L-AmB in patients receiving antifungal therapy and prophylaxis.
authors.affiliation: From M. D. Anderson Cancer Center (AS, RYH, GNM, DPK, KVR, REC, IIR), Houston, Texas; Columbia University (JM), New York, New York; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Sud (FS), Villejuif, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hopital Necker-Enfants Malades (BD), Paris, France; University of Florida College of Medicine (JRW), Gainesville, Florida; Wayne State University, Harper Hospital (PHC), Detroit, Michigan; and National Cancer Institute (TJW), Bethesda, Maryland.
authors.forename: Amar
authors.initials: A
authors.lastname: Safdar
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ma
authors.forename: Fouzi
authors.initials: F
authors.lastname: Saliba
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dupont
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.forename: Ray Y
authors.initials: RY
authors.lastname: Hachem
authors.forename: Gloria N
authors.initials: GN
authors.lastname: Mattiuzzi
authors.forename: Pranatharthi H
authors.initials: PH
authors.lastname: Chandrasekar
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Rolston
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Issam I
authors.initials: II
authors.lastname: Raad
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000666:Amphotericin B / Q000009:adverse effects* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D016503:Drug Delivery Systems; D006801:Humans
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B