Renal effects of amphotericin B lipid complex

Area of Science:

• Mycology
• Nephrology
• Pharmacology

Background:

• Serious fungal infections necessitate effective antifungal treatments.
• Conventional amphotericin B (AmB) is effective but associated with significant nephrotoxicity.
• Lipid formulations like amphotericin B lipid complex (ABLC) were developed to mitigate AmB's adverse effects.

Purpose of the Study:

• To compare the renal effects of amphotericin B lipid complex (ABLC) versus conventional amphotericin B (AmB).
• To evaluate ABLC as a potentially less nephrotoxic alternative for treating invasive fungal infections.

Main Methods:

• Open-label, randomized comparative studies evaluating ABLC (5 mg/kg/d) against AmB (0.6-1 mg/kg).
• Assessment of renal toxicity using serum creatinine changes: doubling of baseline, increase to >1.5 mg/dL, and increase to >2.0 mg/dL.
• Analysis of adverse event reports for nephrotoxicity.

Main Results:

• Fewer patients receiving ABLC reached predefined serum creatinine endpoints compared to AmB (P < 0.007).
• The time to reach these renal toxicity endpoints was significantly shorter for the AmB group (P < 0.02).
• Increased serum creatinine was reported more frequently as an adverse event in the AmB group.
• In an emergency use study, patients with pre-existing renal impairment (creatinine >2.5 mg/dL) showed significant serum creatinine decrease with ABLC.

Conclusions:

• Amphotericin B lipid complex (ABLC) demonstrates a significantly better renal safety profile compared to conventional amphotericin B (AmB).
• ABLC represents a valuable, less nephrotoxic therapeutic option for managing severe invasive fungal infections.
• The findings support the use of ABLC in patients at risk of or experiencing renal impairment during antifungal therapy.