Itraconazole in chronic cavitary pulmonary aspergillosis: a randomised controlled trial and systematic review of literature

被引:112
作者
Agarwal, Ritesh [1 ]
Vishwanath, Gella [1 ]
Aggarwal, Ashutosh N. [1 ]
Garg, Mandeep [2 ]
Gupta, Dheeraj [1 ]
Chakrabarti, Arunaloke [3 ]
机构
[1] Postgrad Inst Med Educ & Res, Dept Pulm Med, Chandigarh 160012, India
[2] Postgrad Inst Med Educ & Res, Dept Radiodiag & Imaging, Chandigarh 160012, India
[3] Postgrad Inst Med Educ & Res, Dept Med Microbiol, Chandigarh 160012, India
关键词
Aspergillus; chronic pulmonary aspergillosis; CCPA; CNPA; aspergilloma; CLINICAL-EFFICACY; MICAFUNGIN; VORICONAZOLE; MULTICENTER; THERAPY; SAFETY;
D O I
10.1111/myc.12075
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Patients with aspergilloma can be safely managed with supportive therapy in absence of massive haemoptysis. We hypothesised that chronic cavitary pulmonary aspergillosis (CCPA) could also be managed on similar grounds. The aim of this prospective, randomised controlled trial was to evaluate the efficacy and safety of itraconazole in CCPA. Consecutive patients of CCPA with presence of chronic pulmonary/systemic symptoms; and pulmonary cavities; and presence of Aspergillus (immunological or microbiological) were randomised to receive either supportive treatment alone or itraconazole 400 mg daily for 6 months plus supportive therapy. Response was assessed clinically, radiologically and overall after 6 months therapy. A total of 31 patients (mean age, 37 years) were randomised to itraconazole (n = 17) or the control (n = 14) group. The number of patients showing overall response was significantly higher in the itraconazole group (76.5%) vs. the control (35.7%) group (P = 0.02). The numbers of patients demonstrating clinical or radiological response were also significantly higher in the itraconazole group (P = 0.016 and 0.01 respectively). Adverse events were noted in eight patients in the itraconazole group, however, none was serious or led to discontinuation of the study drug. Itraconazole was found to be superior to standard supportive treatment alone in stabilising cases of CCPA. (clinicaltrials. gov; NCT01259336).
引用
收藏
页码:559 / 570
页数:12
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