Low-Dose Liposomal Amphotericin Effective in Aspergillosis

NEW ORLEANS—High doses of liposomal amphotericin B are no more effective than low doses in the treatment of invasive aspergillosis in neutropenic patients, European researchers reported at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Dr. Michael Ellis, of the HCI Internal Medicine Center, Glasgow, gave an interim analysis of the first 70 of 119 neutropenic cancer patients from 18 European institutions.

Patients received either low-dose (1 mg/kg) or high-dose (4 mg/kg) liposomal amphotericin B for a median of 20 and 19 days, and a total of 1,260 mg and 4,020 mg of drug, respectively.

Age, sex, performance status, and underlying disease were similar for the two groups. Definite invasive disease was present in 31% of low-dose and 23% of high-dose patients; all other cases were presumptive. Aspergillus fumigatus was the most common pathogen, and the lung was the most common site of infection, usually showing multiple bilateral lesions.

At the end of treatment, a partial or complete clinical response was seen in 68% of low-dose and 49% of high-dose patients. Radiologic response was noted for 63% and 54%, respectively. Overall survival was similar, as was mortality due to invasive aspergillosis (33% low-dose; 28% high-dose). Mortality caused by underlying disease was twice as high in the high-dose group, he said.