A randomised trial of prednisolone versus prednisolone and itraconazole in acute-stage allergic bronchopulmonary aspergillosis complicating asthma
- 9 September 2021
- journal article
- research article
- Published by European Respiratory Society (ERS) in European Respiratory Journal
- Vol. 59 (4), 2101787
- https://doi.org/10.1183/13993003.01787-2021
Abstract
Whether a combination of glucocorticoid and antifungal triazole is superior to glucocorticoid alone, in reducing exacerbations, in patients with allergic bronchopulmonary aspergillosis (ABPA) remains unknown. We aimed to compare the efficacy and safety of prednisolone-itraconazole combination versus prednisolone monotherapy in ABPA. We randomised subjects with treatment-naïve acute-stage ABPA complicating asthma to receive either prednisolone alone (four months) or a combination of prednisolone and itraconazole (four and six months, respectively). The primary outcomes were exacerbation rates at 12 months and glucocorticoid-dependent ABPA within 24 months of initiating treatment. The key secondary outcomes were response rates and percentage decline in serum total IgE at six weeks, time to first ABPA exacerbation, and treatment-emergent adverse effects (AE). We randomised 191 subjects to receive either prednisolone (n=94) or prednisolone-itraconazole combination (n=97). The one-year exacerbation rate was 33% and 20.6% in the prednisolone and the prednisolone-itraconazole arms, respectively (p=0.054). None of the participants progressed to glucocorticoid-dependent ABPA. All the subjects experienced a composite response at 6-weeks, along with a decline in serum total IgE (mean decline, 47.6% versus 45.5%). The mean time to first ABPA exacerbation (417 days) was not different between the groups. None of the participants required modification of therapy due to AE. There was a trend towards a decline in ABPA exacerbations at 1-year with the prednisolone-itraconazole combination than prednisolone monotherapy. A three-arm trial comparing itraconazole and prednisolone monotherapies with their combination, preferably in a multicentric design, is required to define the best treatment strategy for acute-stage ABPA.This publication has 20 references indexed in Scilit:
- Allergic Bronchopulmonary AspergillosisJournal of Fungi, 2016
- Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of AmericaClinical Infectious Diseases, 2016
- A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthmaEuropean Respiratory Journal, 2015
- Fungal allergy in asthma–state of the art and research needsClinical and Translational Allergy, 2014
- Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteriaClinical & Experimental Allergy, 2013
- Itraconazole Comedication Increases Systemic Levels of Inhaled Fluticasone in Lung Transplant RecipientsRespiration, 2006
- Plasma concentrations of inhaled budesonide and its effects on plasma cortisol are increased by the cytochrome P4503A4 inhibitor itraconazoleClinical Pharmacology & Therapeutics, 2002
- A Randomized Trial of Itraconazole in Allergic Bronchopulmonary AspergillosisThe New England Journal of Medicine, 2000
- Adjunctive Therapy of Allergic Bronchopulmonary Aspergillosis with ItraconazoleSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1991
- Pulmonary aspergillosis: Diagnostic and immunological significance of antigens and C‐substance in Aspergillus fumigatusThe Journal of Pathology and Bacteriology, 1964