12-months oral itraconazole most optimal for prevention of relapse of chronic pulmonary aspergillosis: Lancet

Chandigarh, India: 12 months of treatment with oral itraconazole in patients with chronic pulmonary aspergillosis is superior to 6 months of oral itraconazole with regards to reducing relapses at 2 years, reveals a recent study. The findings, published in The Lancet Infectious Diseases, indicate that for treating chronic pulmonary aspergillosis itraconazole should be given for at least 12 months.

Globally, 5-year mortality of chronic pulmonary aspergillosis is 50–80%, and there is no clarity on the optimal duration of chronic pulmonary aspergillosis treatment. Considering this, Inderpaul S Sehgal from Postgraduate Institute of Medical Education and Research, Chandigarh, India, and colleagues aimed to compare the effect of 6-months of oral itraconazole with 12-months of oral itraconazole on chronic pulmonary aspergillosis clinical outcomes in a single-centre, open-label, randomised controlled trial.

The trial was conducted in one chest clinic in Chandigarh, India in which consecutive patients with chronic pulmonary aspergillosis who were naive to antifungal treatment were screened. They were randomized to receive a starting dose of 400 mg/day of oral itraconazole for either 6 months or 12 months. Patients who were unable to provide informed consent; had an intake of any antifungal drugs for more than 3 weeks in the preceding 6 months; had allergic, subacute, or invasive forms of aspergillosis; and had active Mycobacterium tuberculosis or non-tuberculous mycobacterial pulmonary disease were excluded.