title: Efficacy and safety of amphotericin B lipid-based formulations-A systematic review and meta-analysis.
abstract: Invasive fungal infections, an important cause of mortality, are primarily treated using amphotericin B, which is available in different formulations, both conventional and lipid-based (liposomal, lipid complex, colloidal dispersion and Intralipid®infusion). The aim of our study was to determine the efficacy and safety of conventional amphotericin B vs its lipid-based formulations. A systematic review followed by pairwise meta-analysis was performed, including randomised controlled trials (RCTs) that evaluated the use of lipid-based amphotericin B in patients with any degree of immunosuppression and susceptibility to invasive fungal infection. An electronic search was conducted using PubMed, Scopus, Web of Science and Scielo databases. Extracted outcomes were related to efficacy (cure) and safety (incidence of adverse events). Results were evaluated and meta-analyses were performed. Twenty-three RCTs were identified (n=2677 participants) for meta-analysis. No significant differences between conventional amphotericin B and any of the five formulations evaluated were observed, with regard to the efficacy analysis. With respect to the adverse events of nephrotoxicity, fever, chills and vomiting, all lipid formulations presented better profiles than the conventional formulation. The present systematic review and meta-analysis showed that conventional amphotericin B presents the same efficacy profile as lipid-based formulations, although the latter were associated with a safer profile.
authors.affiliation: Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
authors.forename: Laiza M
authors.initials: LM
authors.lastname: Steimbach
authors.affiliation: Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
authors.forename: Fernanda S
authors.initials: FS
authors.lastname: Tonin
authors.affiliation: Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.|Department of Medical and Pharmaceutical Sciences, West-Stadual University of Parana (UNIOESTE), Cascavel, Brazil.
authors.forename: Suzane
authors.initials: S
authors.lastname: Virtuoso
authors.affiliation: Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
authors.forename: Helena H L
authors.initials: HH
authors.lastname: Borba
authors.affiliation: Department of Medical and Pharmaceutical Sciences, West-Stadual University of Parana (UNIOESTE), Cascavel, Brazil.
authors.forename: Andréia C C
authors.initials: AC
authors.lastname: Sanches
authors.affiliation: Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
authors.forename: Astrid
authors.initials: A
authors.lastname: Wiens
authors.affiliation: Department of Social Pharmacy, Research Institute for Medicines (iMed. ULisboa), Faculty of Pharmacy, University of Lisboa, Lisbon, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Llimós
authors.affiliation: Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pontarolo
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003102:Colloids; D004339:Drug Compounding; D004655:Emulsions; D005334:Fever; D006801:Humans; D000072742:Invasive Fungal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D008055:Lipids; D010743:Phospholipids; D013024:Soybean Oil
chemical_list: D000935:Antifungal Agents; D003102:Colloids; D004655:Emulsions; D008055:Lipids; D010743:Phospholipids; C068538:liposomal amphotericin B; C545823:soybean oil, phospholipid emulsion; D000666:Amphotericin B; D013024:Soybean Oil
keywords: amphotericin B; immunosuppression; lipid-based amphotericin B; meta-analysis; systematic review