Abstract | OBJECTIVE: METHODS: Treatment-naive subjects with ABPA complicating asthma (January 2012 to December 2013) were randomized to receive either oral itraconazole or prednisolone for 4 months. The study was not blinded. The primary outcomes were proportion of subjects exhibiting a composite response after 6 weeks, percent decline in IgE after treatment, and numbers of subjects experiencing exacerbation. The secondary outcomes included the time to first exacerbation, change in lung function, and treatment-related adverse effects. RESULTS: A total of 131 subjects ( prednisolone group, n = 63; itraconazole group, n = 68) were included in the study. The number of subjects exhibiting a composite response was significantly higher in the prednisolone group compared with the itraconazole group (100% vs 88%; P = .007). The percent decline in IgE after 6 weeks and 3 months and the number of subjects with exacerbations after 1 and 2 years of treatment were similar in the two groups. The time to first exacerbation (mean: 437 vs 442 days) and the improvement in lung function after 6 weeks was also similar in the two groups. The occurrence of side effects was significantly higher in the glucocorticoid arm (P < .001). CONCLUSIONS:
Prednisolone was more effective in inducing response than itraconazole in acute-stage ABPA. However, itraconazole was also effective in a considerable number and, with fewer side effects compared with prednisolone, remains an attractive alternative in the initial treatment of ABPA. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01321827; URL: www.clinicaltrials.gov).
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Authors | Ritesh Agarwal, Sahajal Dhooria, Inderpaul Singh Sehgal, Ashutosh N Aggarwal, Mandeep Garg, Biman Saikia, Digambar Behera, Arunaloke Chakrabarti |
Journal | Chest
(Chest)
Vol. 153
Issue 3
Pg. 656-664
(03 2018)
ISSN: 1931-3543 [Electronic] United States |
PMID | 29331473
(Publication Type: Journal Article, Randomized Controlled Trial)
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Copyright | Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Antifungal Agents
- Glucocorticoids
- Itraconazole
- Prednisolone
|
Topics |
- Administration, Oral
- Adult
- Antifungal Agents
(administration & dosage, therapeutic use)
- Aspergillosis, Allergic Bronchopulmonary
(complications, drug therapy)
- Asthma
(complications)
- Female
- Glucocorticoids
(administration & dosage, therapeutic use)
- Humans
- Itraconazole
(administration & dosage, therapeutic use)
- Male
- Prednisolone
(administration & dosage, therapeutic use)
- Respiratory Function Tests
- Treatment Outcome
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