Nephrotoxicity of Different Formulations of Amphotericin B: Summarizing Evidence by Network Meta-analysis

TO THE EDITOR—The nephrotoxicity of amphotericin B (AmB) has long been known, but the risk of this side effect can be reduced if the drug is formulated as either an extemporaneous lipid emulsion (AmB-LE) or a liposomal product (AmBLIPO). Information on the relative nephrotoxicity of these formulations is still scarce, and so assessing whether AmBLIPO and/or AmB-LE are less nephrotoxic than conventional AmB (ie, AmB deoxycholate, AmB-Dx) is still a matter of interest [1]. This assessment, however, is hampered by the lack of head-tohead trials comparing AmB-LIPO versus AmB-LE; hence, any comprehensive analysis in this area must rely also on indirect comparisons between the 2 lipid-based formulations. Network meta-analysis is an evidencebased tool that is specifically aimed at these indirect comparisons [2–4]. On the other hand, the similar pattern of nephrotoxicity observed for AmB-LIPO versus AmB-LE [1] raises another methodological question because the indirect comparison between these 2 formulations should be based on a noninferiority design [5].