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Amphotericin B: time for a new "gold standard"
Luis Ostrosky-Zeichner1, Kieren A Marr, John H Rex
1Division of Infectious Diseases, Department of Internal Medicine, Center for the Study of Emerging and Reemerging Pathogens, University of Texas Medical School, Houston, TX, USA. Luis.Ostrosky-Zeichner@uth.tmc.edu
Summary
Safer lipid formulations of amphotericin B (AmB) are now proven as effective as, and sometimes superior to, older amphotericin B deoxycholate (AmBD) for invasive fungal infections. These lipid AmB preparations offer improved safety and can replace AmBD in clinical practice and research.
Area of Science:
- Mycology
- Infectious Diseases
- Pharmacology
Background:
- Amphotericin B deoxycholate (AmBD), introduced in 1959, was a critical antifungal but associated with significant toxicities.
- Historically, AmBD served as the primary comparator in clinical trials due to a lack of early efficacy studies for newer agents.
- Lipid-based amphotericin B (AmB) formulations were primarily approved for salvage therapy due to challenges in clinical trial design.
Purpose of the Study:
- To evaluate the efficacy and safety of lipid-based amphotericin B formulations compared to amphotericin B deoxycholate.
- To determine if lipid formulations are suitable for primary therapy in invasive fungal infections.
- To provide evidence supporting the replacement of AmBD with lipid formulations in clinical practice and research.
Main Methods:
- Review of cumulative clinical experience and published data on lipid-based amphotericin B preparations.
- Comparison of efficacy and toxicity profiles between lipid formulations and AmBD across various invasive fungal infections.
- Analysis of data from randomized studies and real-world clinical use.
Main Results:
- Lipid-based AmB formulations demonstrate comparable or superior antifungal activity to AmBD for specific invasive fungal infections.
- These lipid formulations possess significantly better safety profiles than AmBD.
- Clinical experience now supports the use of lipid formulations as a primary treatment option.
Conclusions:
- Lipid-based amphotericin B preparations are effective and safer alternatives to AmBD.
- These agents can be considered suitable replacements for AmBD in the primary treatment of many invasive fungal infections.
- The findings support a shift in clinical practice and research towards utilizing lipid formulations of AmB.