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Update on the treatment of chronic pulmonary aspergillosis

Darius Armstrong-James1, Chris Kosmidis2, Mike Bromley2

  • 1Department of Infectious Diseases and Imperial Fungal Science Network, Imperial College London, London.

Current Opinion in Infectious Diseases
|March 13, 2023
PubMed
Abstract

Insights

Novel antifungals and immunotherapies show promise for chronic pulmonary aspergillosis, a serious fungal infection. Urgent clinical trials are needed to address emerging antifungal resistance and improve patient outcomes.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Pulmonology

Background:

  • Chronic pulmonary aspergillosis (CPA) is a significant global health concern, particularly affecting individuals with underlying lung conditions or immune deficiencies.
  • Current treatments for CPA are limited to three drug classes: triazoles, echinocandins, and amphotericin B.
  • Emerging resistance to triazoles, the primary oral therapy for CPA, necessitates the exploration of alternative treatment strategies.

Approach:

  • This review synthesizes current management approaches for CPA.
  • It examines novel antifungal agents currently in late-stage development (Phase 3 studies).
  • The potential role of immunotherapies, including interferon-gamma, in CPA treatment is also discussed.

Key Points:

  • Novel antifungal agents are advancing through clinical trials, offering potential new options for CPA.
  • There is a critical need for clinical trials evaluating novel antifungals in CPA, given poor outcomes and triazole resistance.
  • Immunotherapies, particularly those targeting cytokine defects, represent a promising adjunctive treatment avenue for CPA.

Conclusions:

  • The development pipeline includes promising novel antifungals for CPA.
  • Addressing triazole resistance and improving CPA outcomes requires dedicated clinical trials for new agents.
  • Further research into adjunctive immunotherapies is essential for comprehensive CPA management.

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