Itraconazole and prednisolone are compared for ABPA-complicating asthma treatment

Submitted by ROrritt on 5 March 2018

Globally, 5 million people are estimated to be affected by allergic bronchopulmonary aspergillosis (ABPA) complicating asthma, which can progress to fibrosis of the lungs if not diagnosed and treated promptly.

A randomized trial compared the effectiveness of prednisolone and itraconazole in 131 acute-stage ABPA-complicating asthma patients. The patients had not been treated with azoles or glucocorticoids for more than three weeks in the previous year, and received either oral itraconazole or prednisolone for four months.

Patients receiving prednisolone were more likely to show a composite response to treatments at 6 weeks than those receiving itraconazole (p=.007). The percentage decline in IgE was similar in both groups at 6 weeks and at 3 months. The number of patients with complete remission after 3 and 6 months were similar in the two groups, as was the number of patients experiencing exacerbations after 1 or 2 years following treatment. However the occurrence of adverse events was significantly higher in the prednisolone group.

Prednisolone treatment was more effective than itraconazole for acute-stage ABPA. However, itraconazole was still effective in a high proportion of patients (88%), and resulted in fewer adverse events than prednisolone. The authors suggest that itraconazole (with appropriate therapeutic drug monitoring) is an alternate option for this condition. They also note that a comparison with combined itraconazole/prednisolone therapy could yield interesting results in future research.