Antifungal treatment in allergic bronchopulmonary aspergillosis with and without cystic fibrosis: a systematic review

• Type: Another Publication in an International Scientific Journal
• Date: 2014

Authors

Moreira, AS (Author) Other; Silva, D (Author) FMUP; Reis Ferreira, AR (Author) Other; Delgado, L (Author) FMUP

Journal

Title: Clinical and Experimental Allergy

Vol. 44

Pages: 1210-1227

ISSN: 0954-7894

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 42 Citations

Scopus - 54 Citations

Other information

Authenticus ID: P-009-VXH

DOI: 10.1111/cea.12333

Abstract (EN): Allergic bronchopulmonary aspergillosis (ABPA) is a rare disease that affects patients with asthma or cystic fibrosis. Its debilitating course has led to the search for new treatments, including antifungals and monoclonal antibodies. To evaluate the efficacy and safety of antifungal treatments in patients with ABPA and either asthma or cystic fibrosis, we performed a systematic review of the literature on the effects of antifungal agents in ABPA using three biomedical databases. Quality assessment was performed using the GRADE methodology and, where appropriate, studies with comparable outcomes were pooled for meta-analysis. Thirty-eight studies - four randomized controlled trials and 34 observational studies - met the eligibility criteria. The antifungal interventions described were itraconazole, voriconazole, posaconazole, ketoconazole, natamycin, nystatin and amphotericin B. An improvement in symptoms, frequency of exacerbations and lung function was reported in most of the studies and was more common with oral azoles. Antifungals also had a positive impact on biomarkers and radiological pulmonary infiltrates, but adverse effects were also common. The quality of the evidence supporting these results was low or very low due to a shortage of controlled studies, heterogeneity between studies and potential bias. Antifungal interventions in ABPA improved patient and disease outcomes in both asthma and cystic fibrosis. However, the recommendation for their use is weak and clinicians should therefore weigh up desirable and undesirable effects on a case-by-case basis. More studies with a better methodology are needed, especially in cystic fibrosis, to increase confidence in the effects of antifungal treatments in ABPA.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 18