Treatment Of Allergic Bronchopulmonary Aspergillosis Research Articles

Prevalence and features of allergic bronchopulmonary aspergillosis, United States, 2016-2022.

The epidemiology of allergic bronchopulmonary aspergillosis (ABPA) in the United States is not well-described. To estimate national ABPA prevalence among patients with asthma or cystic fibrosis, characterize ABPA testing practices, and describe ABPA clinical features, treatment, and 6-month outcomes. We used the 2016-2022 Merative™ MarketScan® Commercial/Medicare and Multi-State Medicaid Databases to identify cohorts of patients with 1) asthma, 2) cystic fibrosis (CF), and 3) ABPA. We calculated ABPA prevalence per 10,000 patients with asthma or CF, assessed diagnostic testing for ABPA among patients with severe asthma, and described features of patients with ABPA using diagnosis and procedure codes. The overall ABPA prevalence among patients with asthma was 2.8/10,000 (Commercial/Medicare) and 1.0/10,000 (Medicaid). ABPA prevalence increased with asthma severity (Commercial/Medicare: mild 1.3, moderate 9.3, severe 70.6, Medicaid: mild 0.3, moderate 2.4, severe 32.4). Among patients with CF, ABPA prevalence was 183.7/10,000 (Commercial/Medicare) and 134.6/10,000 (Medicaid). Among patients with severe asthma, 10.3% (Commercial/Medicare) and 7.4% (Medicaid) received total immunoglobulin E testing, which is recommended for ABPA diagnosis. Among all patients with ABPA (Commercial/Medicare: n = 1,564, Medicaid: n = 410), ABPA treatments included inhaled corticosteroids (>70%), systemic corticosteroids (>62%), and antifungals (>18%). Patients with ABPA and Medicaid were more likely to experience hospitalization (45.1% vs. 22.5% of patients with Commercial/Medicare insurance) and respiratory failure (18.5% vs. 10.9%). This analysis provides initial estimates of national ABPA prevalence. Further studies could identify potential barriers to ABPA testing and investigate potential factors affecting payer-related differences in ABPA burden.

Trends in the Treatment of Allergic Bronchopulmonary Aspergillosis.

Trends in the Treatment of Allergic Bronchopulmonary Aspergillosis.

Artificial intelligence-driven volumetric CT outcome score in cystic fibrosis: longitudinal and multicenter validation with/without modulators treatment.

Holistic segmentation of CT structural alterations with 3D deep learning has recently been described in cystic fibrosis (CF), allowing the measurement of normalized volumes of airway abnormalities (NOVAA-CT) as an automated quantitative outcome. Clinical validations are needed, including longitudinal and multicenter evaluations. The validation study was retrospective between 2010 and 2023. CF patients undergoing Elexacaftor/Tezacaftor/Ivacaftor (ETI) or corticosteroids for allergic broncho-pulmonary aspergillosis (ABPA) composed the monocenter ETI and ABPA groups, respectively. Patients from six geographically distinct institutions composed a multicenter external group. All patients had completed CT and pulmonary function test (PFT), with a second assessment at 1 year in case of ETI or ABPA treatment. NOVAA-CT quantified bronchiectasis, peribronchial thickening, bronchial mucus, bronchiolar mucus, collapse/consolidation, and their overall total abnormal volume (TAV). Two observers evaluated the visual Bhalla score. A total of 139 CF patients (median age, 15 years [interquartile range: 13-25]) were evaluated. All correlations between NOVAA-CT to both PFT and Bhalla score were significant in the ETI (n = 60), ABPA (n = 20), and External groups (n = 59), such as the normalized TAV (ρ ≥ 0.76; p < 0.001). In both ETI and ABPA groups, there were significant longitudinal improvements in peribronchial thickening, bronchial mucus, bronchiolar mucus and collapse/consolidation (p ≤ 0.001). An additional reversibility in bronchiectasis volume was quantified with ETI (p < 0.001). Intraclass correlation coefficient of reproducibility was > 0.99. NOVAA-CT automated scoring demonstrates validity, reliability and responsiveness for monitoring CF severity over an entire lung and quantifies therapeutic effects on lung structure at CT, such as the volumetric reversibility of airway abnormalities with ETI. Normalized volume of airway abnormalities at CT automated 3D outcome enables objective, reproducible, and holistic monitoring of cystic fibrosis severity over an entire lung for management and endpoints during therapeutic trials. Visual scoring methods lack sensitivity and reproducibility to assess longitudinal bronchial changes in cystic fibrosis (CF). AI-driven volumetric CT scoring correlates longitudinally to disease severity and reliably improves with Elexacaftor/Tezacaftor/Ivacaftor or corticosteroid treatments. AI-driven volumetric CT scoring enables reproducible monitoring of lung disease severity in CF and quantifies longitudinal structural therapeutic effects.

Allergic bronchopulmonary aspergillosis in a lung transplant recipient treated with mepolizumab

Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to Aspergillus spp. ABPA diagnosis may be challenging due to its non-specific presentation. Standard ABPA treatment consists of systemic corticosteroids and antifungal agents. Mepolizumab, a monoclonal antibody against interleukin-5 seems to be a promising treatment for ABPA. Data about ABPA following lung transplantation (LuTx) are scarce. LuTx recipients are at higher risk for adverse effects of ABPA treatment compared to the general population.Here we present a case of a LuTx recipient who was successfully treated with mepolizumab for ABPA following LuTx. Prolonged administration of high dose prednisone was thus avoided. To our knowledge, this is the first case describing mepolizumab administration following LuTx. Mepolizumab seems particularly attractive as a corticosteroid-sparing agent or as an alternative option to antifungal treatments, because of its excellent safety profile and low risk of drug interactions.

A challenge in diagnosis and treatment in asthma patients with allergic bronchopulmonary aspergillosis: a review

Allergic bronchopulmonary aspergillosis (ABPA) is a common form of fungal-related asthma disease mainly caused by Aspergillus fumigatus. The increasing prevalence of asthma globally and the characteristic of Aspergillus are very easily dispersed in the air to inhale, leading to increased cases of ABPA in asthma patients. Inhalation of conidia Aspergillus spp. can trigger asthma exacerbations due to poor mucociliary clearance. However, the exact pathogenesis is still unclear. Clinical features commonly found in ABPA patients are productive cough with dark green or brown mucus or even hemoptysis. Several criteria for establishing the diagnosis of ABPA can be based on clinical features, laboratory examinations, and imaging, but none has become the gold standard. However, the primary laboratory test utilized for ABPA screening is the measurement of serum-specific IgE levels to A. fumigatus, owing to its high sensitivity. Despite the challenges in finding the most fitting universal consensus, most clinicians still follow the criteria proposed by Rosenberg et al. in 1977. The recommended ABPA treatment is prednisone and/or azole antifungal agents such as itraconazole. In addition, the potential of monoclonal antibodies in ABPA therapy is still under further research. Long-term diagnosis and treatment delays can lead to complications such as bronchiectasis and fibrosis. This review aimed to highlight ABPA in asthma patients, from etiopathogenesis to managing the disease

CT Imaging Assessment of Response to Treatment in Allergic Bronchopulmonary Aspergillosis in Adults With Bronchial Asthma

BackgroundOne of the major challenges in managing allergic bronchopulmonary aspergillosis (ABPA) remains consistent and reproducible assessment of response to treatment. Research questionWhat are the most relevant changes in computed tomography (CT-scan) parameters over time for assessing response to treatment? Study Design and MethodsIn this ancillary study of a randomized clinical trial (NEBULAMB), asthmatic patients with available CT-scan and without exacerbation during a 4-month ABPA exacerbation treatment period (corticosteroids and itraconazole) were included. Changed CT-scan parameters were assessed by systematic analyses of CT-scan findings at initiation (M0) and end of treatment (M4). CT-scans were assessed by two radiologists blinded to the clinical data. Radiological parameters were determined by selecting those showing significant changes over time. Improvement of at least one, without worsening of the others, defined the radiological response. Agreement between radiological changes, clinical and immunologic responses was likewise investigated. ResultsAmong the 139 originally randomized patients, 132 were included. We identified 5 CT-scan parameters showing significant changes at M4: mucoid impaction extent, mucoid impaction density, centrilobular micronodules, consolidation/ground-glass opacities and bronchial wall thickening (P<0.05). These changes were only weakly associated with one another, except for mucoid impaction extent and density. No agreement was observed between clinical or immunologic and radiological responses, assessed as an overall response, or considering each of the parameters (Cohen’s κ, -0.01 to 0.24). InterpretationChanges in extent and density of mucoid impactions, centrilobular micronodules, consolidation/ground-glass opacities and thickening of the bronchial walls were found to be the most relevant CT-scan parameters to assess radiological response to treatment. A clinical, immunologic and radiological multidimensional approach should be adopted to assess outcomes, probably with a composite definition of response to treatment.

Clinical Manifestation and Treatment of Allergic Bronchopulmonary Aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to airway colonization by Aspergillus fumigatus in patients with asthma and cystic fibrosis. The pathophysiology of ABPA involves a complex interplay between the fungus and the host immune response, which causes persistent inflammation and tissue damage. Patients present with chronic cough, wheezing, and dyspnea due to uncontrolled asthma. Characteristic symptoms include the expectoration of brownish mucus plugs. Radiographic findings often reveal fleeting pulmonary infiltrates, bronchiectasis, and mucus impaction. However, the definitive diagnosis of ABPA requires a combination of clinical, radiological, and immunological findings. The management of ABPA aims to reduce symptoms, prevent disease progression, and minimize the future risk of exacerbations. The treatment approach involves systemic glucocorticoids or antifungal agents to suppress the inflammatory response or fungal growth and prevent exacerbations. Biological agents may be used in patients with severe disease or glucocorticoid dependence. This review provides an overview of the clinical manifestations and current treatment options for ABPA.

Effectiveness and safety of omalizumab in patients with allergic bronchopulmonary aspergillosis with or without allergic rhinitis: a retrospective chart review

BackgroundOmalizumab is a valuable alternative treatment for allergic bronchopulmonary aspergillosis (ABPA). The effectiveness and safety of this medication have not been confirmed. The main purpose of this study was to evaluate the effectiveness and safety of omalizumab for ABPA.MethodsThis study involved a retrospective chart review. The main indicators used were asthma control test (ACT) scores, lung function parameters, doses of corticosteroids, acute exacerbation, hospitalization rates, total serum immunoglobulin E (IgE) levels, and blood eosinophil counts. Related adverse events were also reviewed to evaluate the safety of omalizumab.ResultsFourteen patients with ABPA were included, of whom 10 (71%) concurrently had allergic rhinitis (AR). There were improvements in the mean percentages of the forced vital capacity, percentages of the forced expiratory volume in 1 s, and ACT score after omalizumab administration (p < 0.05, p < 0.01, and p < 0.01, respectively). After the initiation of omalizumab administration, the median corticosteroid dose, acute exacerbation rate, hospitalization rate, and mean blood eosinophil count decreased when compared with the baseline values (p < 0.05, p < 0.05, p < 0.01, and p < 0.05, respectively). A reduction in the total serum IgE level was observed in patients with ABPA without AR compared with that in patients with AR (p < 0.05). One patient reported a concurrent skin rash, which spontaneously resolved without medication.ConclusionIt is safe and effective to prescribe omalizumab to patients with ABPA, irrespective of whether they have AR. Dose adjustment of omalizumab is safe after disease control. The total serum IgE level might be a predictor of the effectiveness of omalizumab in patients without AR.

Allergic bronchopulmonary aspergillosis: A multidisciplinary review.

Allergic bronchopulmonary aspergillosis (ABPA) is a rare disease characterized by a complex allergic inflammatory reaction of airways against Aspergillus affecting patients with chronic respiratory diseases (asthma, cystic fibrosis). Exacerbation is often the way to diagnose ABPA and marks its evolution by its recurrent character leading to cortico-requirement or long-term antifungal treatment. Early diagnosis allows treatment of ABPA at an initial stage, preventing recurrence of exacerbations and long-term complications, mainly represented by bronchiectasis. This review of the literature aims to present the current state of the art in terms of diagnosis and treatment of ABPA from a multidisciplinary perspective. As there is no clinical, biological nor radiological specific sign, diagnostic criteria are regularly revised. They are mainly based on the elevation of total and specific IgE against Aspergillus fumigatus and the presence of suggestive CT abnormalities such as mucoid impaction and consolidations. ABPA management includes eviction of mold and pharmacological therapy. Exacerbations are treated in first line with a moderate dose of oral corticosteroids. Azole antifungal agents represent an alternative for the treatment of exacerbations and are the preferential strategy to reduce the future risk of exacerbations and for corticosteroids sparing. Asthma biologics may be of interest; however, their place remains to be determined. Avoiding complications of ABPA while limiting the side effects of systemic drugs remains a major challenge of ABPA management. Several drugs, including new antifungals and asthma biologics, are currently being tested and may be useful in the future.

Non-Contrast-Enhanced Functional Lung MRI to Evaluate Treatment Response of Allergic Bronchopulmonary Aspergillosis in Patients With Cystic Fibrosis: A Pilot Study.

Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is associated with severe lung damage and requires specific therapeutic management. Repeated imaging is recommended to both diagnose and follow-up response to treatment of ABPA in CF. However, high risk of cumulative radiation exposure requires evaluation of free-radiation techniques in the follow-up of CF patients with ABPA. To evaluate whether Fourier decomposition (FD) functional lung MRI can detect response to treatment of ABPA in CF patients. Retrospective longitudinal. Twelve patients (7M, median-age:14 years) with CF and ABPA with pre- and post-treatment MRI. 2D-balanced-steady-state free-precession (bSSFP) sequence with FD at 1.5T. Ventilation-weighted (V) and perfusion-weighted (Q) maps were obtained after FD processing of 2D-coronal bSSFP time-resolved images acquired before and 3-9 months after treatment. Defects extent was assessed on the functional maps using a qualitative semi-quantitative score (0 = absence/negligible, 1 = <50%, 2 = >50%). Mean and coefficient of variation (CV) of the ventilation signal-intensity (VSI) and the perfusion signal-intensity (QSI) were calculated. Measurements were performed independently by three readers and averaged. Inter-reader reproducibility of the measurements was assessed. Pulmonary function tests (PFTs) were performed within 1 week of both MRI studies as markers of the airflow-limitation severity. Comparisons of medians were performed using the paired Wilcoxon-test. Reproducibility was assessed using intraclass correlation coefficient (ICC). Correlations between MRI and PFT parameters were assessed using the Spearman-test (rho correlation-coefficient). A P-value <0.05 was considered as significant. Defects extent on both V and Q maps showed a significant reduction after ABPA treatment (4.25 vs. 1.92 for V-defect-score and 5 vs. 2.75 for Q-defect-score). VSI_mean was significantly increased after treatment (280 vs. 167). Qualitative analyses reproducibility showed an ICC > 0.90, while the ICCs of the quantitative measurements was almost perfect (>0.99). Changes in VSI_cv and QSI_cv before and after treatment correlated inversely with changes of FEV1%p (rho = -0.68 for both). Non-contrast-enhanced FD lung MRI has potential to reproducibly assess response to treatment of ABPA in CF patients and correlates with PFT obstructive parameters. 4 TECHNICAL EFFICACY: Stage 3.

Allergic bronchopulmonary aspergillosis in India.

Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder caused by immune-mediated reactions mounted against Aspergillus fumigatus. The disorder most commonly complicates the course of patients with asthma and cystic fibrosis. From its first description in 1952, significant advances have been made in understanding the pathogenesis and the diagnosis and treatment of ABPA. In the last two decades, most research on ABPA has been published from India. The prevalence and clinical presentation may differ in India from that reported elsewhere. Herein, we review the epidemiology, clinical and radiological characteristics, and distinctive features of ABPA in the Indian subcontinent. To support the review, we surveyed pulmonologists nationwide to understand the challenges in diagnosing and managing ABPA. The survey has yielded valuable insights into the practices associated with the diagnosis and management of ABPA in India.

Allergic bronchopulmonary aspergillosis in identical twins: Effectiveness of dupilumab

Allergic bronchopulmonary aspergillosis in identical twins: Effectiveness of dupilumab

Which steroid regimen (low dose or high dose) should be used for the treatment of allergic bronchopulmonary aspergillosis in children with asthma? A systematic review of literature and evidence-based guideline recommendation

Which steroid regimen (low dose or high dose) should be used for the treatment of allergic bronchopulmonary aspergillosis in children with asthma? A systematic review of literature and evidence-based guideline recommendation

Omalizumab in Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Meta-Analysis

An unmet clinical need exists in the management of treatment-refractory allergic bronchopulmonary aspergillosis (ABPA). Omalizumab has shown promising effects in case series and cohort studies; however, evidence to support its routine clinical use is lacking. The aim of this systematic review and meta-analysis was to evaluate the clinical effectiveness and safety of omalizumab in patients with ABPA. We conducted a systematic search across standard databases using specific key words until May 13, 2021. We performed a meta-analysis to compare the effectiveness (exacerbations, oral corticosteroid [OCS] use, lung function, and patient-reported asthma control) and safety of pre- and post-omalizumab treatment. Subgroup analyses were performed for treatment duration and underlying disease. In total, 49 studies (n= 267) were included in the qualitative synthesis and 14 case series (n= 186) in the quantitative meta-analysis. Omalizumab treatment significantly reduced the annualized exacerbation rate compared with pretreatment (mean difference,-2.09 [95% CI,-3.07 to-1.11]; P < .01). There was a reduction in OCS use (risk difference, 0.65 [95% CI, 0.46-0.84]; P < .01), an increase in termination of OCS use (risk difference, 0.53 [95% CI, 0.24-0.82]; P < .01), and a reduction in OCS dose (milligrams per day) (mean difference,-14.62 [95% CI,-19.86 to-9.39]; P < .01) in ABPA patients receiving omalizumab. Omalizumab improved FEV1 % predicted by 11.9% (95% CI, 8.2-15.6; P < .01) and asthma control, and was well-tolerated. Omalizumab treatment reduced exacerbations and OCS use, improved lung function and asthma control in patients with ABPA, and was well-tolerated. The results highlight the potential role of omalizumab in the treatment of ABPA.

Antifungal chemotherapies and immunotherapies for the future.

Human fungal pathogens cause a broad plethora of infections, spanning cutaneous dermatophytoses to invasive infections in immunocompromised hosts. As eukaryotic pathogens are capable of morphotype switching, they present unique challenges both for drug development and the immunological response. Whilst current antifungal therapies are limited to the orally available triazoles, intravenous echonocandins and polyenes, and flucytosine and terbinafine, there has been recent significant progress in the antifungal armamentorium with ibrexafungerp, a novel orally available terpanoid that inhibits 1,3-beta-D-glucan-approved by Food and Drug Administration in 2021, and fosmanogepix, an orally available pro-drug of manogepix, which targets glycosylphosphatidylinositol-anchored protein maturation entering Phase 3 studies for candidaemia. A number of further candidates are in development. There has been significant use of existing immunotherapies such as recombinant interferon-γ and G-CSF for fungal disease in immunocompromised patients, and there are emerging opportunities for monoclonal antibodies targeting TH2 inflammation. Omalizumab, an anti-IgE monoclonal antibody in asthma, is now used routinely for the treatment of allergic bronchopulmonary aspergillosis, and further agents targeting IL-4 and IL-5 are being evaluated. In addition, T-cell CAR therapy is showing early promise for fungal disease. Thus, we are likely to see rapid advances to our approach to the management of fungal disease in the near future.

Expert consensus on the diagnosis and treatment of allergic bronchopulmonary aspergillosis(2022 update)

As an allergic lung disease caused by Aspergillus species, allergic bronchopulmonary aspergillosis(ABPA) is manifested by asthma and recurrent lung infiltrates, often with signs of bronchiectasis. ABPA is not uncommon, but under-diagnosis/misdiagnosis and inappropriate management are common in clinical practice, due to the varied manifestations, inconsistent diagnostic criteria, and the need of complicated laboratory studies. To improve the diagnosis and treatment of ABPA, experts of the Asthma Group of Chinese Thoracic Society proposed an expert consensus on the diagnosis and treatment of ABPA in 2017 (1 st Edition). Its publication has been well received by the Chinese physicians, and promoted the appropriate management of the disease. In the past 5 years, advances have been made in the investigation into the mechanisms, and in the diagnosis and therapy of ABPA, including novel insight into the pathogenesis, more studies of the diagnostic criteria, and more evidence on the efficacy of glucocorticoid, antifungal and/or biologic therapies. Based on new evidence and the clinical practice in China, experts of the Asthma Group of Chinese Thoracic Society updated the consensus.

Antifungal therapies for allergic bronchopulmonary aspergillosis in people with cystic fibrosis.

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic reaction to colonisation of the lungs with the fungus Aspergillus fumigatus, and affects around 10% of people with cystic fibrosis. ABPA is associated with an accelerated decline in lung function. High doses of corticosteroids are the main treatment for ABPA; although the long-term benefits are not clear, and their many side effects are well-documented. A group of compounds, the azoles, have activity against A fumigatus, and have been proposed as an alternative treatment for ABPA. Of this group, itraconazole is the most active. A separate antifungal compound, amphotericin B, has been used in aerosolised form to treat invasive infection with A fumigatus, and may have potential for the treatment of ABPA. Antifungal therapy for ABPA in cystic fibrosis needs to be evaluated. This is an update of a previously published review. The review aimed to test the hypotheses that antifungal interventions for the treatment of ABPA in cystic fibrosis: 1. improve clinical status compared to placebo or standard therapy (no placebo); and 2. do not have unacceptable adverse effects. If benefit was demonstrated, we planned to assess the optimal type, duration, and dose of antifungal therapy. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals, and abstract books of conference proceedings. Date of the most recent search of the Group's Trials Register was 28 September 2021. We searched ongoing trials registries, most recently on 11 March 2022. Earlier, we also approached pharmaceutical companies regarding possible unpublished trials. Published or unpublished randomised controlled trials, in which antifungal treatments were compared to either placebo or no treatment, or where different doses of the same treatment were used in the treatment of ABPA in people with cystic fibrosis. The searches identified six trials; none of which met the inclusion criteria for the review. We included no completed randomised controlled trials. There is currently one ongoing trial, which we may find eligible for a future update. At present, there are no randomised controlled trials that evaluate the use of antifungal therapies for the treatment of ABPA in people with cystic fibrosis, although one trial is currently ongoing. Trials with clear outcome measures are needed to properly evaluate the use of corticosteroids in people with ABPA and cystic fibrosis.

Allergic Bronchopulmonary Aspergillosis in Children Presenting as Lung Masses.

Allergic bronchopulmonary aspergillosis (ABPA) is an IgE-mediated hypersensitivity reaction predominantly occurring in patients of asthma and cystic fibrosis. The typical radiological findings in ABPA include central bronchiectasis and fleeting opacities. In this retrospective study, the aim was to describe cases of ABPA in children who had a mass-like lesion in the lung. There were 5 cases of ABPA in children, who presented as mass-like lesions that responded very well to treatment for ABPA. All cases, except 1, had asthma as the underlying disease. There was a delay in the diagnosis of ABPA in all 5 cases. There had been unnecessary invasive investigations in some of these cases before the diagnosis of ABPA was made. To conclude, children with ABPA may present with a mass-like lesion in the lung and high index of suspicion is required to diagnose ABPA timely to prevent its consequences.

Biologic drugs in treating allergic bronchopulmonary aspergillosis in patients with cystic fibrosis: a systematic review.

Aspergillus fumigatus is a common saprophytic fungus causing allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis (CF). The recommended first-line treatment for ABPA is oral steroids, followed by antifungal therapy. However, both treatments are not free from adverse effects; thus, efforts are being made to identify new drugs showing the same effectiveness but with fewer or no side-effects. Therein, biologic drugs have been significantly implemented in clinical practice in treating ABPA in patients with CF. To systematically review the available literature, providing evidence for the administration of biologic drugs as a new potential treatment of ABPA in both the paediatric and adult populations with CF. A systematic review of the literature published between January 2007 and July 2021 was performed, using a protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42021270932). A total of 21 studies focusing on the use of biologics in treating ABPA in CF patients was included. We highlighted a paucity of data providing evidence for biologic drug use in ABPA. Scientific evidence is insufficient to support firm conclusions and randomised clinical trials are urgently required to investigate the efficacy and safety of biologics for ABPA in CF patients.

EPS5.02 Effect of omalizumab on glucocorticoid use and lung function in the treatment of allergic bronchopulmonary aspergillosis in people with cystic fibrosis: a systematic review and meta-analysis

ePS5.02 Effect of omalizumab on glucocorticoid use and lung function in the treatment of allergic bronchopulmonary aspergillosis in people with cystic fibrosis: a systematic review and meta-analysis