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Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B: a review and

Amar Safdar1, Jonathan Ma, Fouzi Saliba

  • 1From M. D. Anderson Cancer Center (AS, RYH, GNM, DPK, KVR, REC, IIR), Houston, Texas; Columbia University (JM), New York, New York; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Sud (FS), Villejuif, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hopital Necker-Enfants Malades (BD), Paris, France; University of Florida College of Medicine (JRW), Gainesville, Florida; Wayne State University, Harper Hospital (PHC), Detroit, Michigan; and National Cancer Institute (TJW), Bethesda, Maryland.

Medicine
|July 10, 2010
PubMed

Insights

This meta-analysis compared nephrotoxicity of amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AmB). Results suggest similar nephrotoxicity between ABLC and L-AmB in patients receiving antifungal therapy.

Area of Science:

  • Mycology
  • Pharmacology
  • Nephrology

Background:

  • Lipid formulations of amphotericin B (AmB) are used for fungal infections, offering reduced nephrotoxicity over conventional AmB.
  • A comprehensive comparison of nephrotoxicity between different AmB lipid preparations is lacking.

Purpose of the Study:

  • To conduct a meta-analysis evaluating and comparing nephrotoxicity associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AmB).

Main Methods:

  • Systematic literature search of PubMed MEDLINE and scientific meeting abstracts (1995-2008).
  • Meta-analysis of 8 selected studies (n=1160) comparing nephrotoxicity of ABLC versus L-AmB.
  • Cochran-Mantel-Haenszel and Breslow-Day tests were used for odds ratio (OR), relative risk (RR), and homogeneity analysis.

Main Results:

  • Initial analysis of 8 studies (n=1160) indicated higher nephrotoxicity with ABLC versus L-AmB (OR, 1.75; RR, 1.55), with significant heterogeneity (p < 0.001).
  • Excluding one study and focusing on salvage populations reduced heterogeneity and showed similar nephrotoxicity (OR, 1.31; RR, 1.24; n=916; then OR, 1.12; RR, 1.09; n=839).
  • The 7 remaining studies after exclusion were more homogenous (p = 0.054).

Conclusions:

  • Nephrotoxicity appears generally similar between ABLC and L-AmB in patients undergoing antifungal therapy and prophylaxis.
  • Careful consideration of study populations and heterogeneity is crucial when comparing AmB lipid formulations.

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