Itraconazole for chronic pulmonary aspergillosis: Longer is better
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A randomized controlled trial in India demonstrated that 12 months of oral itraconazole was superior to a 6-month regimen in reducing relapses of chronic pulmonary aspergillosis, researchers reported in The Lancet Infectious Diseases.
“We had observed chronic pulmonary aspergillosis relapses in about 50% of patients treated with 6 months of oral itraconazole after treatment discontinuation. Also, many patients required prolonged therapy with oral itraconazole,” Inderpaul S. Sehgal, MD, DM, an assistant professor in the department of pulmonary medicine at the Postgraduate Institute of Medical Education and Research in Chandigarh, told Healio.
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Sehgal and colleagues conducted a single-center, open-label, randomized controlled trial at one chest clinic in Chandigarh. Between July 1, 2019, and Aug. 31, 2021, they randomly assigned 164 patients with chronic pulmonary aspergillosis who were naive to antifungal treatment to receive a starting dose of 400 mg per day of oral itraconazole for either 6 months or 12 months. The primary outcome of the study was the proportion of patients who relapsed 2 years after treatment initiation.
According to the study, 10% of patients in the 12-month treatment group experienced relapse compared with 38% in the 6-month group (adjusted RR = 0.29; 95% CI, 0.16-0.4). The mean time to first relapse was 23 months in the 12-month group and 18 months in the 6-month group (P < .0001).
Additionally, the researchers reported that there were eight deaths in each group, and that 12% of patients in the 6-month group and 22% in the 12-month group experienced adverse events.
“Symptomatic subjects with chronic pulmonary aspergillosis should be treated with at least 12 months of oral itraconazole,” Sehgal said. “The benefit of a longer duration of treatment is even more in those with severe disease at presentation — two or more cavities on chest imaging.”
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