COMPARATIVE EFFECTIVENESS AND SAFETY BETWEEN AMPHOTERICIN B LIPID-FORMULATIONS: A SYSTEMATIC REVIEW

Area of Science:

• Infectious Diseases
• Nephrology
• Pharmacology

Background:

• Invasive fungal infections (IFIs) pose significant challenges, particularly in patients with renal impairment or toxicity concerns with conventional amphotericin B (d-AmB).
• Lipid formulations of amphotericin B, including amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AmB), are alternatives, but their comparative efficacy and safety in specific patient subgroups remain unclear.

Purpose of the Study:

• To systematically review and compare the effectiveness and safety of ABLC versus L-AmB.
• To focus on patient subgroups with IFIs refractory to d-AmB, pre-existing renal impairment, or unacceptable d-AmB-induced renal toxicity.

Main Methods:

• A comprehensive literature search was conducted across Medline, Cochrane Library, EMBASE, and LILACS databases.
• Five observational studies, selected from 1,054 identified articles, met the inclusion criteria for analysis.
• Data extraction and quality assessment were performed independently by two investigators.

Main Results:

• No statistically significant differences were observed in clinical outcomes such as mortality, length of hospital stay, or new-onset dialysis between ABLC and L-AmB.
• A trend towards lower nephrotoxicity was noted with L-AmB, but these findings were characterized by imprecision and heterogeneity.
• The included studies exhibited important methodological biases, limiting the robustness of the results.

Conclusions:

• Current evidence suggests a potential for reduced nephrotoxicity with L-AmB compared to ABLC in specific patient populations.
• However, due to the low quality of evidence and lack of statistically significant differences in key clinical outcomes, definitive superiority of either lipid formulation cannot be established.
• Further high-quality research is warranted to clarify the comparative benefits of ABLC and L-AmB in managing IFIs in vulnerable patient groups.