Publication Date:
2005-11-16
Description:
Amphotericin B deoxycholate (AmBd) nephrotoxicity increases morbidity and mortality however there are no clear guidelines when to switch to liposomal amphotericin B (LAB). We evaluated the benefit of Early Switch (ES) to LAB in patients with AmBd compared to Late Switch (LS). In this prospective randomized multicenter trial, standard AmBd 1mg/kg/d is initiated in neutropenic patients with haematological malignancies as empirical antifungal therapy (V0). If serum creatinine (SCr) increased of 30% from baseline V0, they were randomized (V1) to LAB 3mg/kg/d (ES) or to pursue AmBd (no switch). In a second step, AmBd treated patients were switched to LAB (LS) if their serum creatinine doubled from V0 or reached a value ≥ 170 μmol/l up to the end of treatment (V2). The analysis included 29 patients [ES=14; no switch=15 with late switch for 9 of them]. Demographics and mean duration of AmBd treatment prior randomization were similar in both groups. Early switch allowed a statistically significant (p=0.04) decrease in serum creatinine (−3.1%) from V1 to V2 as compared with a mean increase of +16.2% in the LS + no switch groups and also demonstrated a significant (p=0.04) increase (+5.1%) in creatinine clearance (ml/min) compared to a decrease (−10.3%) in the LS + no switch groups. This randomised trial demonstrated that an early switch to LAB improves and preserves renal function compared with late switch. Significant reduction of drug-induced nephrotoxicity may impact positively clinical outcomes and provide patients with greater options for chemotherapy treatments. Evolution of renal function Criteria (mean) ES LS + no switch p SCr at V0 (μmol/l) 67.2 67.3 NS SCr at V1 (μmol/l) 109.0 108.2 NS SCr at V2 (μmol/l) 104.5 123.1 0.08 Evolution of SCr V1 - V2 (%) − 3.1 + 16.2 0.04 Evolution of ClCr V1 - V2 (%) + 5.1 − 10.3 0.04
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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