Study reconsiders primary therapy for invasive aspergillosis

Using liposomal amphotericin B (L-AmB) as a primary treatment for invasive aspergillosis, a serious fungal infection that can spread from the lungs to other organs via the bloodstream, is as effective as the current standard treatment, according to new research published in Open Forum Infectious Diseases.  

Historically, clinical guidelines have recommended a family of antifungals known as triazoles as the primary form of treatment for invasive aspergillosis. However, with increased rates of drug-resistant invasive aspergillosis and frequent use of these drugs as prophylaxis, the presumed efficacy of triazoles versus L-AmB calls for examination, according to researchers.  

“Our findings indicate that L-AmB can be as effective and safe as triazoles for the initial treatment of patients with invasive aspergillosis,” said Dr. Maddalena Giannella, full professor of infectious diseases at University of Bologna and senior infectious diseases consultant at IRCCS Azienda Ospedaliero-Universitaria di Bologna. 

People who are at risk for invasive aspergillosis include those with weakened immune systems, such as patients with cancer or undergoing organ transplantation; those with chronic lung disease; and, in recent years, patients with acute respiratory distress syndrome due to the flu or COVID-19. Prompt diagnosis and initiation of antifungals are keys to treating invasive aspergillosis.  

“Considering the rise in drug resistance in invasive aspergillosis and the issues related to the use of triazoles, particularly voriconazole, such as the need of therapeutic drug monitoring and drug-drug interactions, we deem these data reassuring that L-AmB is an effective alternative to initial triazole-based treatment,” said Dr. Matteo Rinaldi, clinical researcher at the University of Bologna and infectious diseases consultant at IRCCS Azienda Ospedaliero-Universitaria di Bologna. 

The study analyzed the records of 401 patients with confirmed or probable invasive aspergillosis at two academic hospitals in Italy over a 10-year period. Researchers compared different variables, including underlying disease, time to initial treatment, primary treatment type (L-AmB, triazole or a combination) and mortality rates. They found that L-AmB was as effective as triazoles, with 90-day survival rates being similar. Notably, L-AmB therapy was preferred for patients who were considered higher risk, including those with hematologic cancers and those who had taken triazoles prophylactically but still acquired invasive aspergillosis.  

“Importantly, our data suggested that toxicities with L-AmB are avoided with switching to triazoles once the pathogen and/or the susceptibility is known,” said Dr. Russell Lewis, associate professor of infectious diseases, University of Padua. 

Experts note that more prospective trials comparing L-AmB with modern triazoles are still needed.  

In addition to Dr. Giannella, Dr. Rinaldi and Dr. Lewis, study authors include: Maria Chiara Susini, Bianca Nuti, Martina Casarini, Daniele Riccucci, Irene Grassi, Alice Toschi, Michele Bartoletti, Linda Bussini, Davide Fiore Bavaro, Valeria Cento, Lucia Diella, Alessandra Belati, Alessandro De Angelis, Diletta Barbanotti, Giulia Pensalfine, Simone Ambretti, Greta Roncarati and Pierluigi Viale. 

About OFID 

Open Forum Infectious Diseases is a fully open-access journal advancing the field of infectious diseases by publishing and promoting high-quality research that improves patient care and public health outcomes. Our goal is to foster collaboration among practitioners, researchers and policymakers by providing a platform for the exchange of knowledge and ideas. The journal focuses on publishing innovative clinical and translational research, exploring the impact of the natural environment on infectious diseases, enhancing publication literacy among infectious diseases practitioners and addressing global health challenges. Visit academic.oup.com/ofid to learn more. 

About IDSA 

The Infectious Diseases Society of America is a global community of 13,000 clinicians, scientists and public health experts working together to solve humanity’s smallest and greatest challenges, from tiny microbes to global outbreaks. Rooted in science, committed to health equity and driven by curiosity, our compassionate and knowledgeable members safeguard the health of individuals, our communities and the world by advancing the treatment and prevention of infectious diseases. Visit idsociety.org to learn more.