Antifungal treatment in allergic bronchopulmonary aspergillosis with and without cystic fibrosis: a systematic review.

[allergic bronchopulmonary aspergillosis]

Allergic bronchopulmonary aspergillosis (ABPA ) is a rare disease that affects patients with asthma or cystic fibrosis . Its debilitating course has led to the search for new treatments , including antifungals and monoclonal antibodies . To evaluate the efficacy and safety of antifungal treatments in patients with ABPA and either asthma or cystic fibrosis , we performed a systematic review of the literature on the effects of antifungal agents in ABPA using three biomedical databases . Quality assessment was performed using the GRADE methodology and , where appropriate , studies with comparable outcomes were pooled for meta -analysis . Thirty -eight studies - four randomized controlled trials and 34 observational studies - met the eligibility criteria . The antifungal interventions described were itraconazole , voriconazole , posaconazole , ketoconazole , natamycin , nystatin and amphotericin B . An improvement in symptoms , frequency of exacerbations and lung function was reported in most of the studies and was more common with oral azoles . Antifungals also had a positive impact on biomarkers and radiological pulmonary infiltrates , but adverse effects were also common . The quality of the evidence supporting these results was low or very low due to a shortage of controlled studies , heterogeneity between studies and potential bias . Antifungal interventions in ABPA improved patient and disease outcomes in both asthma and cystic fibrosis . However , the recommendation for their use is weak and clinicians should therefore weigh up desirable and undesirable effects on a case-by -case basis . More studies with a better methodology are needed , especially in cystic fibrosis , to increase confidence in the effects of antifungal treatments in ABPA .

Diseases
Validation

Diseases presenting "cystic fibrosis" symptom

allergic bronchopulmonary aspergillosis

canavan disease

congenital adrenal hyperplasia

wiskott-aldrich syndrome

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