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

Published online by Cambridge University Press:  13 June 2018

Luiza Raquel Grazziotin ,
Leila Beltrami Moreira  and
Maria Angelica Pires Ferreira
Luiza Raquel Grazziotin
Affiliation:
Department of Community Health Sciences, University of Calgaryluiza.grazziotinlago@ucalgary.ca
Leila Beltrami Moreira
Affiliation:
Health Technology Assessment Unit, Hospital de Clinicas de Porto Alegre
Maria Angelica Pires Ferreira
Affiliation:
Health Technology Assessment Unit, Hospital de Clinicas de Porto Alegre
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Abstract

Objectives:

It is not yet established the advantages between amphotericin B lipid complex (ABLC) and liposomal (L-AmB) in patients with invasive fungal infections refractory to usual doses of conventional AmB (d-AmB), previous renal impairment, or unacceptable d-AmB renal toxicity. This systematic review aims to compare ABLC and L-AmB effectiveness and safety outcomes in these subgroups of patients.

Methods:

The search was performed on Medline, Cochrane Library, EMBASE, and LILACS databases. Inclusion criteria: treatment comparing L-AmB with ABLC; patients who had (i) refractory infection after being treated with d-AmB, (ii) previous renal impairment, or (iii) unacceptable d-AmB toxicity. Two investigators independently screened the search results, assessed trial quality, and extracted data. A total of 1,054 articles were identified in the literature. Among those, eleven were selected for full-text reading and five met the inclusion criteria.

Results:

The five articles included reported on four separate observational studies. Overall, no significant difference was found in clinical relevant outcomes as new-onset dialysis, length of hospital stay, or mortality when comparing both lipid formulations. The studies reported a trend toward lower nephrotoxicity in patients treated with L-AmB. However, the results were imprecise and heterogeneous and the studies presented important methodological biases.

Conclusions:

The studies included in this systematic review pointed toward less nephrotoxicity events in the L-AmB group. However, due to low quality of evidence and no statistically significant differences in other clinical relevant outcomes, there is no definitive evidence of overall superiority in effectiveness or safety outcomes regarding one lipid formulation or another in this population subgroup.

Keywords

Liposomal amphotericin BAmphotericin B lipid complexAntifungal agentsNephrotoxicityRenal impairment
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 34 , Issue 3 , 2018 , pp. 343 - 351
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

References

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