Antifungal therapies for allergic bronchopulmonary aspergillosis in people with cystic fibrosis

Pulmonary Aspergillosis in People with Cystic Fibrosis

“…Any environmental source responsible for continuous exposure to A. fumigatus must be eliminated. 86 87 88 89 In addition, the treatment with biologicals has been described and published in the past years. The following biologicals are approved only for asthma but have also been used as a first-line treatment of acute ABPA in pwCF.…”

Pulmonary Aspergillosis in People with Cystic Fibrosis

“…Any environmental source responsible for continuous exposure to A. fumigatus must be eliminated. 86 87 88 89 In addition, the treatment with biologicals has been described and published in the past years. The following biologicals are approved only for asthma but have also been used as a first-line treatment of acute ABPA in pwCF.…”

Cystic Fibrosis Lung Disease: An Overview

“…67 The addition of closely monitored antifungal therapy has been used by some centers in an attempt to reduce the antigen burden in the airways. 68 Omalizumab, a humanized anti-IgE monoclonal antibody, may be a potentially useful steroid-sparing agent; however, a recent Cochrane review concluded that omalizumab cannot be definitively recommended in CF patients with allergic bronchopulmonary aspergillosis given the absence of supporting data from randomized controlled trials. 69 Clinical studies suggest that chronic endobronchial cocolonization with P. aeruginosa and A. fumigatus is common and is associated with worsened status and prognosis, but it remains unclear whether this relationship contributes to progression of lung disease or is only a marker.…”

Clinical Relevance of Fungi in Cystic Fibrosis

“…It is speculated that they reduce the fungal burden, limit the inflammatory response, and, thus, provide a steroid-sparing effect; however, no randomized, controlled trials have been conducted to date. 57 In practice, antifungal drugs—and especially itraconazole—is frequently administered at a dose of 5 mg/kg/day for 3 to 6 months. 39 Itraconazole has limited oral bioavailability and only approximately 50% of pwCF achieve therapeutic blood levels.…”

Pulmonary Aspergillosis in People with Cystic Fibrosis

“…Any environmental source responsible for continuous exposure to A. fumigatus must be eliminated. 86 87 88 89 In addition, the treatment with biologicals has been described and published in the past years. The following biologicals are approved only for asthma but have also been used as a first-line treatment of acute ABPA in pwCF.…”

Cystic Fibrosis Lung Disease: An Overview

“…67 The addition of closely monitored antifungal therapy has been used by some centers in an attempt to reduce the antigen burden in the airways. 68 Omalizumab, a humanized anti-IgE monoclonal antibody, may be a potentially useful steroid-sparing agent; however, a recent Cochrane review concluded that omalizumab cannot be definitively recommended in CF patients with allergic bronchopulmonary aspergillosis given the absence of supporting data from randomized controlled trials. 69 Clinical studies suggest that chronic endobronchial cocolonization with P. aeruginosa and A. fumigatus is common and is associated with worsened status and prognosis, but it remains unclear whether this relationship contributes to progression of lung disease or is only a marker.…”

Clinical Relevance of Fungi in Cystic Fibrosis

“…It is speculated that they reduce the fungal burden, limit the inflammatory response, and, thus, provide a steroid-sparing effect; however, no randomized, controlled trials have been conducted to date. 57 In practice, antifungal drugs—and especially itraconazole—is frequently administered at a dose of 5 mg/kg/day for 3 to 6 months. 39 Itraconazole has limited oral bioavailability and only approximately 50% of pwCF achieve therapeutic blood levels.…”

Pulmonary Aspergillosis in People with Cystic Fibrosis

“…Any environmental source responsible for continuous exposure to A. fumigatus must be eliminated. 86 87 88 89 In addition, the treatment with biologicals has been described and published in the past years. The following biologicals are approved only for asthma but have also been used as a first-line treatment of acute ABPA in pwCF.…”

Cystic Fibrosis Lung Disease: An Overview

“…67 The addition of closely monitored antifungal therapy has been used by some centers in an attempt to reduce the antigen burden in the airways. 68 Omalizumab, a humanized anti-IgE monoclonal antibody, may be a potentially useful steroid-sparing agent; however, a recent Cochrane review concluded that omalizumab cannot be definitively recommended in CF patients with allergic bronchopulmonary aspergillosis given the absence of supporting data from randomized controlled trials. 69 Clinical studies suggest that chronic endobronchial cocolonization with P. aeruginosa and A. fumigatus is common and is associated with worsened status and prognosis, but it remains unclear whether this relationship contributes to progression of lung disease or is only a marker.…”

Clinical Relevance of Fungi in Cystic Fibrosis

“…It is speculated that they reduce the fungal burden, limit the inflammatory response, and, thus, provide a steroid-sparing effect; however, no randomized, controlled trials have been conducted to date. 57 In practice, antifungal drugs—and especially itraconazole—is frequently administered at a dose of 5 mg/kg/day for 3 to 6 months. 39 Itraconazole has limited oral bioavailability and only approximately 50% of pwCF achieve therapeutic blood levels.…”