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Itraconazole in chronic cavitary pulmonary aspergillosis: a randomised controlled trial and systematic review of literature
Author(s) -
Agarwal Ritesh,
Vishwanath Gella,
Aggarwal Ashutosh N.,
Garg Mandeep,
Gupta Dheeraj,
Chakrabarti Arunaloke
Publication year - 2013
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.12075
Subject(s) - itraconazole , medicine , aspergilloma , discontinuation , aspergillosis , randomized controlled trial , adverse effect , surgery , gastroenterology , lung , antifungal , immunology , dermatology
Summary Patients with aspergilloma can be safely managed with supportive therapy in absence of massive haemoptysis. We hypothesised that chronic cavitary pulmonary aspergillosis ( CCPA ) could also be managed on similar grounds. The aim of this prospective, randomised controlled trial was to evaluate the efficacy and safety of itraconazole in CCPA . Consecutive patients of CCPA with presence of chronic pulmonary/systemic symptoms; and pulmonary cavities; and presence of Aspergillus (immunological or microbiological) were randomised to receive either supportive treatment alone or itraconazole 400 mg daily for 6 months plus supportive therapy. Response was assessed clinically, radiologically and overall after 6 months therapy. A total of 31 patients (mean age, 37 years) were randomised to itraconazole ( n = 17) or the control ( n = 14) group. The number of patients showing overall response was significantly higher in the itraconazole group (76.5%) vs. the control (35.7%) group ( P = 0.02). The numbers of patients demonstrating clinical or radiological response were also significantly higher in the itraconazole group ( P = 0.016 and 0.01 respectively). Adverse events were noted in eight patients in the itraconazole group, however, none was serious or led to discontinuation of the study drug. Itraconazole was found to be superior to standard supportive treatment alone in stabilising cases of CCPA . (clinicaltrials.gov; NCT01259336).