Reuters Health Information (2005-08-02): Liposomal amphotericin B may be hard on the liver in bone marrow recipients
Liposomal amphotericin B may be hard on the liver in bone marrow recipients
Last Updated: 2005-08-02 16:11:57 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In bone marrow transplant
recipients, antifungal therapy with liposomal amphotericin B or
fluconazole can be toxic to the liver, independent of other treatments
received or patient characteristics, a study shows. The magnitude of
the risk is larger with liposomal amphotericin B, Boston-based
investigators report in the August 1st issue of Clinical Infectious
"Systemic fungal infection is an important infectious complication
of bone marrow transplantation," Dr. Michael A. Fischer and colleagues
from Brigham and Women's Hospital point out in their report.
"Systemic antifungal medications can be lifesaving but can also have important toxicities."
Dr. Fischer's team evaluated the relationship between hepatotoxicity
and exposure to antifungal medications in a population of several
hundred patients receiving bone marrow transplants.
"What was striking about our study was that there was a stronger
association of liver toxicity with liposomal amphotericin B than with
fluconazole," Dr. Fischer told Reuters Health. The odds ratios for
hepatotoxicity with liposomal amphotericin B and fluconazole were 3.33
and 1.99, respectively. The observed association between exposure to
fluconazole and hepatotoxicity has been shown previously.
In a follow-up analysis of patients who developed hepatotoxicity and
continued on antifungal therapy, the researchers found that most
appeared to tolerate continued therapy with fluconazole, whereas a
large fraction (one third) had "worsening conditions" with continued
liposomal amphotericin B therapy.
Summing up, Dr. Fischer said a "key message for doctors would be to
monitor patients on these medications very carefully for any signs of
liver damage, but it is important to keep in mind that this is an
observational study and that the association which we observed does not
"Hopefully our findings will stimulate additional research on this
topic to provide more definite answers on the precise risks of these
antifungal medications," Dr. Fischer concluded.
The authors of an editorial say this report "reminds us that we should not overlook the hepatotoxic potential of the polyenes."
Although the cumulative literature suggests that most cases of
polyene-related liver toxicity are mild, "the potential for severe
toxicity exists, particularly in some patient groups for whom other
drugs or complications may conspire to exacerbate hepatic injury," Drs.
John R. Wingard and Helen Leather from the University of Florida in
"This concern should not, in our view, dissuade one from use of the
polyenes, when justified, but this study should lead us to consider
alternatives when hepatotoxicity occurs," they conclude.
Clin Infect Dis 2005;41:301-310.