Effectiveness of voriconazole in the treatment of Aspergillus fumigatus-associated asthma (EVITA3 study)

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:134

Article

Agbetile, Joshua ; Bourne, Michelle ; Fairs, Abbie ; Hargadon, Beverley ; Desai, Dhananjay ; Broad, Clare ; Morley, Joseph ; Bradding, Peter ; Brightling, Christopher E. ; Green, Ruth H. ; Haldar, Pranabashis ; Pashley, Catherine H. ; Pavord, Ian D. ; Wardlaw, Andrew J.

关键词: Refractory;    asthma;    exacerbations;    Aspergillus fumigatus;    allergic bronchopulmonary aspergillosis;    mold;    eosinophils;    voriconazole;    quality of life;    severe asthma with fungal sensitization;   

DOI  :  10.1016/j.jaci.2013.09.050

来源: Elsevier

【 摘 要 】

Background: IgE sensitization to Aspergillus fumigatus and a positive sputum fungal culture result are common in patients with refractory asthma. It is not clear whether these patients would benefit from antifungal treatment. Objectives: We sought to determine whether a 3-month course of voriconazole improved asthma-related outcomes in patients with asthma who are IgE sensitized to A fumigatus. Methods: Asthmatic patients who were IgE sensitized to A fumigatus with a history of at least 2 severe exacerbations in the previous 12 months were treated for 3 months with 200 mg of voriconazole twice daily, followed by observation for 9 months, in a double-blind, placebo-controlled, randomized design. Primary outcomes were improvement in quality of life at the end of the treatment period and a reduction in the number of severe exacerbations over the 12 months of the study. Results: Sixty-five patients were randomized. Fifty-nine patients started treatment (32 receiving voriconazole and 27 receiving placebo) and were included in an intention-to-treat analysis. Fifty-six patients took the full 3 months of medication. Between the voriconazole and placebo groups, there were no significant differences in the number of severe exacerbations (1.16 vs 1.41 per patient per year, respectively; mean difference, 0.25; 95% CI, 0.19-0.31), quality of life (change in Asthma Quality of Life Questionnaire score, 0.68 vs 0.88; mean difference between groups, 0.2; 95% CI, 20.05 to 20.11), or any of our secondary outcome measures. Conclusion: We were unable to show a beneficial effect of 3 months of treatment with voriconazole in patients with moderate-to-severe asthma who were IgE sensitized to A fumigatus on either the rate of severe exacerbations, quality of life, or other markers of asthma control.

【 授权许可】

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