Amphotericin B Lipid Complex for Invasive Fungal Infections: Analysis of Safety and Efficacy in 556 Cases

TLDR

The study evaluated the safety and antifungal efficacy of amphotericin B lipid complex (ABLC) in 556 patients with invasive fungal infections who were refractory to or intolerant of conventional therapy in an open‑label, emergency‑use setting. ABLC treatment was safe and effective, with serum creatinine decreasing significantly, and a 57 % overall response rate (42 % aspergillosis, 67 % candidiasis, 71 % zygomycosis, 82 % fusariosis) among 291 evaluable cases, supporting its use in patients intolerant or refractory to standard antifungals.

Abstract

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 ⩾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 < .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.