Liu Min, Yang Honghong, Liu Qian, He Kun, Yuan Jing, Chen Yaokai
Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, People's Republic of China.
Infect Drug Resist. 2024 Dec 14;17:5581-5593. doi: 10.2147/IDR.S481856. eCollection 2024.
Amphotericin B deoxycholate (AmB-D) have potential toxic effects in the treatment of talaromycosis, and high-quality, non-generic liposomal AmB (L-AMB) is still inaccessible in many regions of China. As such, the efficacy and safety of alternative drugs warrant further investigation for the management of talaromycosis. This study aimed to compare the efficacy and safety of Amphotericin B Colloidal Dispersion (ABCD) and AmB-D for the treatment of talaromycosis in a retrospective cohort of HIV-infected patients.
This was a retrospective study and the data of HIV-infected patients with talaromycosis who received ABCD or AmB-D from January 2018 to December 2022, were retrospectively collected and analyzed. We compared the efficacy and safety of the two antifungal drugs.
Overall, 38 patients receiving ABCD and 33 patients receiving AmB-D were included. The conversion rates to fungal negativity at one week post-treatment were 86.84% (33/38) in the ABCD group and 90.09% (30/33) in the AmB-D group, which reached 100.00% in both groups at two weeks post-treatment. A higher symptom remission rate was observed at two weeks in the ABCD group compared with the AmB-D group (94.74% vs 75.76%; =0.003). Additionally, the serum creatinine level significantly increased from baseline in the AmB-D group, whereas it did not increase significantly in the ABCD group. Furthermore, significantly fewer patients discontinued antifungal treatment due to drug intolerance in the ABCD group, and the incidences of leukopenia and elevated creatinine levels were lower in the ABCD group compared with the AmB-D group.
ABCD has a clinical efficacy comparable to AmB-D, with higher symptom remission rate, lower nephrotoxicity, and lower bone marrow suppression, indicating that ABCD may be an appropriate alternative option for the clinical management of talaromycosis.
两性霉素B去氧胆酸盐（AmB-D）在治疗塔拉霉病时具有潜在毒性作用，在中国许多地区，高质量的非仿制脂质体两性霉素B（L-AMB）仍然无法获得。因此，替代药物的疗效和安全性值得进一步研究以用于塔拉霉病的治疗。本研究旨在比较两性霉素B胶体分散体（ABCD）和AmB-D在一组HIV感染患者回顾性队列中治疗塔拉霉病的疗效和安全性。
这是一项回顾性研究，回顾性收集并分析了2018年1月至2022年12月期间接受ABCD或AmB-D治疗的HIV感染塔拉霉病患者的数据。我们比较了两种抗真菌药物的疗效和安全性。
总体而言，纳入了38例接受ABCD治疗的患者和33例接受AmB-D治疗的患者。治疗后1周时真菌转阴率在ABCD组为86.84%（33/38），在AmB-D组为90.09%（30/33），治疗后2周时两组均达到100.00%。与AmB-D组相比，ABCD组在2周时观察到更高的症状缓解率（94.74%对75.76%；P=0.003）。此外，AmB-D组血清肌酐水平较基线显著升高，而ABCD组未显著升高。此外，ABCD组因药物不耐受而停止抗真菌治疗的患者明显更少，与AmB-D组相比，ABCD组白细胞减少和肌酐水平升高的发生率更低。
ABCD具有与AmB-D相当的临床疗效，症状缓解率更高，肾毒性更低，骨髓抑制更低，表明ABCD可能是塔拉霉病临床治疗的合适替代选择。
