Efficacy of amphotericin B in a fat emulsion for the treatment of cryptococcal meningitis in AIDS patients

Abstract

Several formulae have been developed in an attempt to reduce the toxicity of amphotericin B (AmB), but their high costs preclude widespread use. The aim of this study was to evaluate the efficacy of amphotericin B in a fat emulsion, i.e. Intralipid (AmB-IL), in 37 AIDS patients with cryptococcal meningitis (CM). We retrospectively reviewed data collected in a non-comparative open study between January 1999 and December 2001. The therapeutic cure was defined as complete resolution or improvement of the clinical symptoms or complete absence or improvement of the mycological alterations of the CSF. The outcomes were evaluated at 2 weeks, induction phase (IP), and at the end of treatment or consolidation phase (CP) with the last available CSF. Prior to the diagnosis of CM, 72% of patients had had one or more OI and 67.57% had a concomitant OI. The median CD 4 -cell count was 32 cells/mm 3 , the median leukocyte count in the CSF was 29 cells/mm 3 and the median cumulative dose of AmB-IL was 1,200 mg (300-2,500). The therapeutic cure was 57.14% in the IP and 64.86% in the CP. During IP, 9 patients died (24.32%) and 4 (10.81%) during the CP (p=0.2). Thus, the overall mortality rate was 35.14%. AmB-IL, an inexpensive preparation, might be an alternative to conventional AmB. Some questions remain such as its compatibility, stability and level of toxicity. The benefit is especially important in developing countries, where no drugs other than AmB are available to treat systemic fungal infections.

Efficacy and safety of amphotericin B formulations: a network meta-analysis and a multicriteria decision analysis

“…No further relevant clinical trials or research were conducted: the most recent cohort study dates from 2007, and the publication years of the trials identified in our review range from 1992 to 1999. [26,[57][58][59][60][61][62][63][64] This may be probably due some difficulties in the healthcare services, such as lack of infrastructure and trained personnel to prepare and standardize AB-Intralipid formulations. Thus, clinical practice has focused on experience with LAB, ABCD and ABLC as attractive approaches to provide safer and accessible strategies, [54] ignoring their high costs, which may be a crucial consideration in many countries.…”

Efficacy and safety of amphotericin B lipid‐based formulations—A systematic review and meta‐analysis

“…Chavanet et al . suggested that adverse events associated with amphotericin B could be reduced using an infusion of d‐AmB in Intralipid ® (a parenteral nutrition fat emulsion) . Although some studies have reported differences between these formulations, systematic reviews have reported conflicting evidence.…”

Lipid Systems for the Delivery of Amphotericin B in Antifungal Therapy

“…However, due to the high cost of the lipid formulations, in resource-limited settings that rely only on the conventional AmB formulation for the treatment of systemic fungal infections, extemporaneous fat emulsions have been alternatively prepared by mixing AmB-DOC with Intralipid ® 20%, a low-cost commercial water-in-oil (O/W) emulsion for parenteral nutrition containing 20% (w/v) soybean oil [130,131]. AmB-DOC in Intralipid ® (AmB-IL) has shown antifungal efficacy in vitro [132] and in vivo in experimental animal models of systemic candidiasis [133,134] and aspergillosis [135], similar to that of the conventional formulation in dextrose but decreased nephrotoxicity and infusion-related side effects.…”