TY - JOUR
T1 - Comparative efficacy of amphotericin B lipid complex and liposomal amphotericin B for the treatment of invasive fungal infections in HSCT recipients and other immunocompromised patient populations with hematologic malignancies
T2 - A critical review
AU - Mehta, Jayesh
AU - Blake, Julie
AU - Craddock, Charles
PY - 2011
Y1 - 2011
N2 - Amphotericin B is an important agent for the treatment of invasive fungal infections in immunocompromised patients because of its broad spectrum. However, its toxicities and the availability of alternative agents limit its application. Lipid-based formulations of amphotericin B, such as amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB), are less nephrotoxic and as effective as conventional amphotericin B. However, because of their similarities, choosing between the two formulations remains a challenge. The majority of prospective and retrospective comparative studies have shown equivalence in terms of efficacy although some subset analyses favor ABLC over L-AMB. While both drugs penetrate well in the reticuloendothelial system, ABLC gets concentrated in the lungs to a much greater extent. This may have clinical implications because the lungs are the commonest site of invasive fungal infections. L-AMB is associated with less infusion-related adverse effects and less nephrotoxicity than ABLC. ABLC has been shown to be more cost-effective than L-AMB, although this is affected by variable institutional contracts and pricing. The choice between the two drugs should be based upon due consideration of all these factors.
AB - Amphotericin B is an important agent for the treatment of invasive fungal infections in immunocompromised patients because of its broad spectrum. However, its toxicities and the availability of alternative agents limit its application. Lipid-based formulations of amphotericin B, such as amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB), are less nephrotoxic and as effective as conventional amphotericin B. However, because of their similarities, choosing between the two formulations remains a challenge. The majority of prospective and retrospective comparative studies have shown equivalence in terms of efficacy although some subset analyses favor ABLC over L-AMB. While both drugs penetrate well in the reticuloendothelial system, ABLC gets concentrated in the lungs to a much greater extent. This may have clinical implications because the lungs are the commonest site of invasive fungal infections. L-AMB is associated with less infusion-related adverse effects and less nephrotoxicity than ABLC. ABLC has been shown to be more cost-effective than L-AMB, although this is affected by variable institutional contracts and pricing. The choice between the two drugs should be based upon due consideration of all these factors.
KW - Amphotericin B lipid complex
KW - Fungal infections
KW - Immunocompromised patients
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U2 - 10.2174/1874418401105010023
DO - 10.2174/1874418401105010023
M3 - Article
AN - SCOPUS:79958123315
SN - 1874-4184
VL - 5
SP - 23
EP - 29
JO - Open Transplantation Journal
JF - Open Transplantation Journal
ER -