Retrospective study of the renal effects of amphotericin B lipid complex when used at higher-than-recommended dosages and longer durations compared with lower dosages and shorter durations in patients with systemic fungal infections

Abstract

Background: Patients with fungal infections who are treated with amphotericin B lipid complex (ABLC) often receive dosages less than that recommended in the product information (5 mg/kg·d). This occurs despite the described safety and increased efficacy in select patients treated with higher ABLC dosages. Objective: The purpose of this study was to compare the renal effects of high-dosage/long-duration (HDos/LDur) ABLC therapy (>5 mg/kg·d for >12 days) with those of low-dosage/short-duration (LDos/SDur) ABLC therapy (≤5 mg/kg·d for ≤12 days). Methods: Male and female ABLC-treated patients of all ages were prospectively enrolled, and data were retrospectivelycollected for those who had received ≥4 ABLC doses according to a large, multicenter patient database, the Collaborative Exchange of Antifungal Research (CLEAR) registry. The safety profile of each dosage was evaluated using serum creatinine concentration (S-Cr) and calculated creatinine clearance (CCcr). Results: A total of 1726 patients were studied. The HDos/LDur group included 309 patients and theLDos/SDur group included 1417 patients. The median ages of the HDos/LDur and LDos/SDur groups were 42 and 48 years, respectively (ranges, <1 to 83 and <1 to 95 years; P < 0.001); females comprised 51% and 42% of the 2 populations ( P = 0.004); and 6% and 12% had solid tumors ( P = 0.002). The HDos/LDur group was more likely than the LDos/SDur group to have been treated for multiple systemic fungal pathogen infections (16% and 9%, respectively) and for mold infections (28% and 12%, respectively) (both, P < 0.001). The median change in S-Cr from baseline was 0.1 mg/dL in both groups (range, −4.9 to 5 mg/dL in the HDos/LDur group and −3.96 to 4.7 mg/dL in the LDos/SDur group). No increased risk for renal dysfunction, as reflected in the median change from baseline in CCcr, was observed in either cohort (−3 mL/min [range, −118.65 to 69.03 mL/min] in the HDos/LDur group; −2.17 mL/min [range, −107.48 to 104.45 mL/min] in the LDos/SDur group). Conclusion: These data suggest that higher ABLC dosages appear to be as well tolerated as lower dosages, warrantingfurther study of ABLC dosages >5 mg/kg·d for >12 days in the treatment of systemic fungal infections.