Efficacy and safety of amphotericin B lipid-based formulations-A systematic review and meta-analysis

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Invasive fungal infections (IFIs) are a significant cause of mortality, especially in immunocompromised patients.
• Amphotericin B is a primary antifungal agent, available in conventional and various lipid-based formulations.
• Understanding the comparative efficacy and safety of these formulations is crucial for clinical decision-making.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials (RCTs) comparing conventional amphotericin B with its lipid-based formulations.
• To evaluate the efficacy (cure rates) and safety (adverse events) of these different amphotericin B formulations.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Scopus, Web of Science, Scielo).
• Pairwise meta-analysis was performed on data from 23 RCTs involving 2677 participants.
• Outcomes assessed included treatment cure and incidence of adverse events such as nephrotoxicity, fever, chills, and vomiting.

Main Results:

• No statistically significant difference in efficacy was found between conventional amphotericin B and any of the lipid-based formulations.
• Lipid formulations demonstrated a significantly better safety profile, with lower incidence of nephrotoxicity, fever, chills, and vomiting compared to conventional amphotericin B.

Conclusions:

• Conventional amphotericin B and its lipid-based formulations exhibit comparable efficacy in treating invasive fungal infections.
• Lipid-based amphotericin B formulations are associated with improved safety and reduced adverse events, making them a preferable option in clinical practice.