The association between different regimens of glucocorticoid and antifungal treatment with the prognosis of allergic bronchopulmonary aspergillosis: a retrospective cohort study.
Optimal management of allergic bronchopulmonary aspergillosis (ABPA) remains debated, particularly regarding glucocorticoid (GC) dosage, duration, antifungal selection, and combination therapy. This study evaluated the impact of different regimens on ABPA prognosis.
A total of 76 ABPA patients at Zhongshan Hospital, Fudan University from March 2009 to June 2018 were enrolled and stratified by one-year relapse status. Demographics, treatment details (GC dosage, GC duration, antifungal type), and outcomes (GC dependence, acute exacerbations, lesion resolution, recurrence) were analyzed. Multivariate logistic regression analysis was utilized.
No significant difference were observed between the relapse group (n = 20) and non-relapse group (n = 56) in baseline demographics, clinical characteristics, or use of GC duration/dosage or antifungals. The mean follow-up time for the relapse and non-relapse groups were 23.95 vs 24.91 months. The former had higher long-term GC use (>3 months) than the non-relapse group (80% vs. 30.36%, p < 0.001). Long-term GC was an independent risk factor for relapse (OR 6.85, 95%CI 1.51-31.51), GC dependence (OR 5.92, 95%CI 1.29-27.11), and acute exacerbations (OR 9.41, 95%CI 2.76-32.06). Conversely, low-dose GC (<7.5 mg/day) reduced relapse risk (OR 0.06, 95%CI 0.01-0.36), GC dependence (OR 0.07, 95%CI 0.01-0.41), and exacerbations (OR 0.16, 95%CI 0.03-0.91). Voriconazole offered superior initial efficacy vs itraconazole (OR 4.42, 95%CI 1.18-16.52) but poorer long-term lesion resolution (OR 0.24, 95%CI 0.06-0.97). Nevertheless, a higher proportion of non-relapse patients had received combination therapy compared to relapse patients (67.9% vs. 50%, p = 0.322).
Long-term GC increases risks of adverse outcomes in ABPA, while low-dose GC demonstrates protective effects. Voriconazole provides better initial response but inferior long-term lesion resolution compared to itraconazole. More non-relapse patients on combination therapy may related to possible benefit of combination therapy. Prospective studies are warranted to confirm these findings.
A total of 76 ABPA patients at Zhongshan Hospital, Fudan University from March 2009 to June 2018 were enrolled and stratified by one-year relapse status. Demographics, treatment details (GC dosage, GC duration, antifungal type), and outcomes (GC dependence, acute exacerbations, lesion resolution, recurrence) were analyzed. Multivariate logistic regression analysis was utilized.
No significant difference were observed between the relapse group (n = 20) and non-relapse group (n = 56) in baseline demographics, clinical characteristics, or use of GC duration/dosage or antifungals. The mean follow-up time for the relapse and non-relapse groups were 23.95 vs 24.91 months. The former had higher long-term GC use (>3 months) than the non-relapse group (80% vs. 30.36%, p < 0.001). Long-term GC was an independent risk factor for relapse (OR 6.85, 95%CI 1.51-31.51), GC dependence (OR 5.92, 95%CI 1.29-27.11), and acute exacerbations (OR 9.41, 95%CI 2.76-32.06). Conversely, low-dose GC (<7.5 mg/day) reduced relapse risk (OR 0.06, 95%CI 0.01-0.36), GC dependence (OR 0.07, 95%CI 0.01-0.41), and exacerbations (OR 0.16, 95%CI 0.03-0.91). Voriconazole offered superior initial efficacy vs itraconazole (OR 4.42, 95%CI 1.18-16.52) but poorer long-term lesion resolution (OR 0.24, 95%CI 0.06-0.97). Nevertheless, a higher proportion of non-relapse patients had received combination therapy compared to relapse patients (67.9% vs. 50%, p = 0.322).
Long-term GC increases risks of adverse outcomes in ABPA, while low-dose GC demonstrates protective effects. Voriconazole provides better initial response but inferior long-term lesion resolution compared to itraconazole. More non-relapse patients on combination therapy may related to possible benefit of combination therapy. Prospective studies are warranted to confirm these findings.
Authors
Zhang Zhang, Xu Xu, Wang Wang, Chen Chen, Wang Wang, Zhu Zhu, Li Li, Wang Wang, Jiang Jiang
View on Pubmed