265. Evaluation of Amphotericin B Lipid Formulations as Treatment of Severe coccidioidomycosis
Session: Poster Abstract Session: Endemic Mycosis
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Evaluation of Amphotericin B Lipid Formulations as Treatment of Severe Coccidioidomycosis IDSA poster 265.pdf (1.1 MB)
  • Background: Kern County has amongst the highest burden of coccidioidomycosis-related hospitalizations in California. Patients with severe disease are often treated with a lipid formulation of amphotericin B, either amphotericin B lipid complex (ABLC) or liposomal amphotericin B (L-AmB). Outcomes data with these agents in severe coccidioidomycosis (cocci) is currently lacking. The purpose of this is study is to evalute the efficacy of ABLC and L-AmB in treating severe cocci. 

    Methods: A retrospective, pre-post study design was employed. Chart reviews were completed from 01/01/2000 to 12/31/2014 for all patients who received lipid based amphotericin B. Inclusion criteria included having a follow up complement fixation (CF) titer or a treatment emergent adverse event (TEAE) prior to follow up. Those with meningeal involvement and pregnant patients were excluded. Treatment outcomes were assessed using Mycosis Study Group (MSG) scores, with success being defined as a 50% decrease in MSG score. Data were analyzed using Pearson’s chi-square, Fischer’s exact tests and Wilcoxon Rank Sum when appropriate. This study is IRB approved.

    Results: A total of 121 patients were identified, 71 of which met inclusion criteria. There were no statistical differences in demographics (gender, age, ethnicity, and comorbid conditions) or cocci disease burden (symptoms, CF titers, MSG score) in those that received ABLC and those that received L-AmB, except those who received L-AmB were more likely to have previously diagnosed chronic kidney disease (nL-AmB=4, 12.5% vs nABLC=0, 0.0%; p=0.042) and have a lower creatinine clearance at the start of therapy (L-AmB=79.6 mg/dL vs ABLC=100.4 mg/dL; p=0.008). Successful treatment was achieved in 27 (73.0%) of ABLC patients and 22 (68.8%) of L-AmB patients (p=0.700). Amphotericin B was discontinued due to documented completion of therapy for 23 (53.5%) ABLC patients and 19 (57.6%) L-AmB patients (p=0.722). Acute kidney injury (AKI) was the documented reason of treatment cessation for 10 (23.3%) ABLC and 1 (3.0%) L-AmB patient (p=0.019).

    Conclusion: ABLC and liposomal L-AmB both appear to be equally efficacious in the treatment of severe cocci. L-AmB may have less renal toxicity than ABLC and may be the preferred agent in baseline renal impairment.

    David Benjamin Lash, Pharm.D., MPH1, Arash Heidari, M.D.2, Ritam Grewal, M.D.3 and Royce H. Johnson, M.D., F.A.C.P., FIDSA2, (1)Pharmacy, Kern Medical Center, Bakesrfiled, CA, (2)Infectious Diseases, Kern Medical Center/UCLA, Bakersfield, CA, (3)Internal Medicine, Kern Medical Center/UCLA, Bakersfield, CA

    Disclosures:

    D. B. Lash, None

    A. Heidari, None

    R. Grewal, None

    R. H. Johnson, None

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