Review of current and future therapeutics in ABPA

Abstract

Allergic bronchopulmonary aspergillosis is an allergic pulmonary condition caused by hypersensitivity to antigens of Aspergillus sp. found most commonly in patients with underlying asthma or cystic fibrosis. Host factors which alter the innate and adaptive immune responses to this abundant airborne fungus contribute to the development of chronic airway inflammation, bronchiectasis, and fibrosis. Traditionally, treatment has focussed on reducing fungal burden and immune response to fungal antigens. However, a significant proportion of patients continue to suffer recurrent exacerbations with progressive lung damage, and the side effect burden of existing treatments is high. New treatments including novel antifungal agents, monoclonal antibodies against aspects of the adaptive immune response as well as targeted immunotherapies may be better tolerated and achieve improved outcomes but have not yet been studied in large-scale randomised control trials.

Allergic Bronchopulmonary Aspergillosis with an Atypical Mass-Like Presentation

“…Antifungal therapy based on currently available evidence depends on patient-specific risks, with the following indications; facilitate reduction or tapering of steroids when further exacerbation developed [ 30 ]. Oral first-generation triazole, i.e.…”

ABPA sans asthma: an entity to remember

“…There have been a few case reports of biologicals, such as omalizumab, being used to treat specific cases of ABPA. All patients with bronchiectasis should receive training on airway clearance techniques for better clearance of mucus plugs and secretions 9. In the absence of asthma or airway disease, the use of antifungals seems prudent, but further studies are needed for prompt diagnosis and management of this rare condition.…”

Eosinophilic respiratory disorders and the impact of biologics

“…Reports of treating ABPA patients with underlying cystic fibrosis using omalizumab show more conflicting results [40]. Further cases reporting off-label use of Mepolizumab and Benralizumab have shown reduction in peripheral eosinophilia and symptomatic improvement in ABPA [38]. Another case report demonstrated Dupilumab efficacy in a patient with asthma and ABPA whose symptoms were previously refractory to various treatments including maximal inhaler therapy, oral glucocorticoids, itraconazole, omalizumab, and Benralizumab [41].…”

“…Traditionally, management of ABPA has been with chronic oral glucocorticoids. Antifungal agents have been used as adjuvant therapies however their use is controversial given the paucity of supporting clinical research, in addition to their side effect profiles [38].…”