Role of Deferasirox as an Adjuvant to Parenteral Antifungal Therapy in Invasive Fungal Sinusitis

Abstract

Background: Invasive Fungal Sinusitis(IFS) is seen in both immunocompromised and immunocompetent patients. All fungi elaborate uptake mechanisms to sequester iron, and produce siderophores with higher affinity for iron. The availability of iron and ability to utilize them are essential for viability and growth of Mucor and Aspergillus. Currently, IFS is dealt with surgical debridement and aggressive medical therapy. Amphotericin B being currently used in medical management. Considering the importance of iron in fungal growth, addition of iron chelating agent as an adjunct has potential beneficial role. The newer iron chelator deferasirox, share higher affinity for iron and hence, deprive the fungi of iron, inhibiting their growth. However, the evidence for deferasirox as adjunct therapy in IFS is limited thus, prompting us for this study. Aim: To study the role of deferasirox as an adjuvant to parenteral antifungal therapy in invasive fungal sinusitis. Materials and Methods: A prospective interventional comparative clinical study was conducted. A total of 42 IFS patients were selected for study. About 12 patients were lost due to attrition. Remainder of 30 patients were evenly randomized into Group A and B by chit allocation. After surgical debridement, Patients in group A received only parenteral Amphotericin B and group B received parenteral Amphotericin B and oral deferasirox. The outcomes in two groups were compared clinically,endoscopically and radiologically and analysed using Mann Whitney test. Conclusion: Parenteral Amphotericin B and deferasirox combination is better than parenteral Amphotericin B alone in treatment of IFS.