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Liposomal amphotericin B (AmBisome®) at beginning of its third decade of clinical use
Franco Aversa1, Alessandro Busca2, Anna Candoni3
1a Department of Clinical and Experimental Medicine, Hematology and BMT Unit , University of Parma , Parma , Italy.
Abstract:
Haematologists have been using liposomal amphotericin-B (L-AMB) since 1993 and despite the introduction of several novel antifungal agents over the past decade, their propensity to prescribe L-AMB remains unchanged. Although antifungal guidelines strongly recommend voriconazole as the drug of choice in the treatment of probable and proven invasive fungal disease (IFD), L-AMB is widely used in the real life because of its several advantages in terms of wide anti-mould spectrum, tolerability and efficacy. Furthermore, the concept that L-AMB is endowed with immune-modulating effects, which may have a role in fighting IFD, represent another reason for its use in patients who do not tolerate an excess of inflammation. Finally, given its tolerability and safety, L-AMB is an ideal partner for combining therapy, particularly with echinocandins with which shares the immunological properties that result in a synergistic effect.
Insights
Hematologists continue to prescribe liposomal amphotericin-B (L-AMB) for invasive fungal disease (IFD) due to its broad antifungal spectrum, safety, and immune-modulating properties, often in combination therapy.
Area of Science:
- Mycology
- Pharmacology
- Infectious Diseases
Background:
- Liposomal amphotericin-B (L-AMB) has been a mainstay in treating invasive fungal disease (IFD) since 1993.
- Despite newer agents, L-AMB remains widely prescribed by hematologists due to its clinical advantages.
- Antifungal guidelines often favor voriconazole, but real-world practice differs.
Purpose of the Study:
- To explore the reasons behind the continued preference for L-AMB in clinical practice.
- To highlight the benefits of L-AMB, including its spectrum of activity, tolerability, and efficacy.
- To discuss the potential immune-modulating effects and synergistic properties of L-AMB in combination therapy.
Main Methods:
- This is a review of current clinical practice and literature regarding L-AMB use.
- Analysis of reasons for L-AMB prescription in hematology.
- Evaluation of L-AMB's properties in comparison to newer antifungal agents.
Main Results:
- L-AMB offers a broad anti-mould spectrum, good tolerability, and proven efficacy.
- Its immune-modulating effects are considered beneficial, especially in inflammatory conditions.
- L-AMB demonstrates favorable safety and tolerability for combination therapy, particularly with echinocandins.
Conclusions:
- L-AMB remains a valuable therapeutic option for invasive fungal disease in hematology.
- Its efficacy, safety profile, and immune-modulating properties support its continued use.
- L-AMB is an ideal agent for combination therapy, offering synergistic effects with echinocandins.
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