Itraconazole therapy effective treatment option in patients with Allergic fungal rhinosinusitis

Allergic fungal rhinosinusitis (AFRS) was first reported as a distinct clinical entity in 1976. AFRS is coupled with the clinical entity of fungus ball (mycetoma) as a form of noninvasive fungal sinus disease, separate from and unrelated to invasive fungal sinus pathology.

Currently, the most practiced treatment for allergic fungal rhinosinusitis (AFRS) is surgical debridement along with topical or systemic steroids. However, prolonged systemic steroid therapy comes with a cost on the patient causing several side effects. Systemic antifungals have been used earlier as an adjunct to steroids or in refractory cases, but they have not been used as the sole primary treatment.

A recent study looked into the effectiveness of sole Itraconazole therapy in patients with AFRS by comparison of clinical, radiological, and biochemical parameters before and after treatment, there was a improvement in people in whom steroids are contradicted and surgery still remains as the primary option for complete clearence. The findings are published in the journal Laryngoscope.

Researchers recruited thirty-four patients diagnosed with localized sino-nasal AFRS were recruited and started on the tablet Itraconazole 200 mg orally twice daily for 3 months with q2weekly monitoring of liver function tests. The baseline clinical, radiological, and biochemical parameters were then compared with those after completion of 3 months of Itraconazole therapy.

The key findings of the study are

• There was significant difference between all the parameters-clinical: SNOT-22 score (p < 0.001) and Meltzer endoscopy score (p < 0.001).

• radiological: Lund-Mackay score (p = 0.004) and 20-point CT score (p = 0.002), and biochemical: serum total IgE (p < 0.001), Aspergillus-specific IgE (p < 0.001).

• absolute eosinophil count (p < 0.001). The clearance of the disease was more in anterior sinuses than the posterior ones.

Researchers concluded “Prolonged Itraconazole can be given as sole therapy in AFRS, especially in patients for whom steroids are contraindicated or in those who are awaiting surgery. It can result in symptomatic and radiological improvement, but surgery still remains the definitive treatment option for AFRS for complete clearance of disease.”

Reference: Shah B, Kajal S, Bhalla AS, Madan K, Viswanathan GK, Thakar A, Sikka K, Bairwa M, Verma H. Prolonged Itraconazole Therapy as Sole Treatment for Patients with Allergic Fungal Rhinosinusitis. Laryngoscope. 2023 Jun 28. doi: 10.1002/lary.30841. Epub ahead of print. PMID: 37377280.