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Itraconazole Effective For Allergic Bronchopulmonary Aspergillosis In Cystic Fibrosis

High-dose itraconazole, as monotherapy or in combination with systemic glucocorticosteroids, is effective in cystic fibrosis patients with allergic bronchopulmonary aspergillosis (ABPA).

Danish researchers observed no hepatotoxicity in cystic fibrosis ABPA patients treated with itraconazole long-term.

Investigators from the National University Hospital in Copenhagen point out that ABPA is potentially fatal in cystic fibrosis patients because of the dual-type immune response provoked by fungal antigens.

Itraconazole is considered a useful steroid-sparing agent because long-term corticosteroid treatment can have serious side effects.

A retrospective follow-up was done of 21 patients selected from 250 cystic fibrosis patients treated once or twice within one five-year period. Of the 21 patients, nine were treated with systemic glucocorticosteroids and itraconazole; 12 received the drug as monotherapy.

The percentage of (italics) Aspergillus fumigatus (end italics) (AF)-positive sputum cultures were reduced significantly with itraconazole treatment.

Precipitating antibodies to AF decreased significantly in all patients. Forced expiratory volume in one second increased to pre-exacerbation levels.

The researchers add that total IgE levels decreased in 42 percent of patients on monotherapy and 56 percent of those on combined therapy. Specific IgE radioallergosorbent level decreased in six patients.

Investigators also note that 11 patients had transient increased levels of alanine transaminase.
Allergy, 2002; 57: 723-728. "Itraconazole treatment of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis"

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