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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
"lung function"
symptom
allergic bronchopulmonary aspergillosis
congenital diaphragmatic hernia
lymphangioleiomyomatosis
monosomy 21
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