Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B

A review and meta-analysis

Amar Safdar, Jonathan Ma, Fouzi Saliba, Bertrand Dupont, John R. Wingard, Ray Y. Hachem, Gloria N. Mattiuzzi, Pranatharthi H. Chandrasekar, Dimitrios P. Kontoyiannis, Kenneth V. Rolston, Thomas J. Walsh, Richard E. Champlin, Issam I. Raad

Research output: Contribution to journalArticle

Abstract

Lipid preparations of amphotericin B, commonly used to treat fungal infections, have been demonstrated to have reduced nephrotoxicity compared to conventional amphotericin B. However, to our knowledge, a comprehensive comparison of nephrotoxicity induced by different lipid preparations of amphotericin B has not been performed. We conducted a meta-analysis to evaluate nephrotoxicity associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AmB).We searched the PubMed MEDLINE database and abstracts presented at key scientific meetings, and identified 11 studies reported between 1995 and 2008 that compared nephrotoxicity resulting from the use of these agents. Eight of the 11 studies were included in the meta-analysis. The Cochran-Mantel-Haenszel test was used to determine odds ratio (OR) and relative risk (RR), and the Breslow-Day test was used to analyze homogeneity of ORs across different studies.Analysis of all 8 studies (n = 1160) included in the meta-analysis showed an increased probability of nephrotoxicity in patients treated with ABLC versus L-AmB (OR, 1.75; RR, 1.55), but there was a significant lack of homogeneity across these studies (p <0.001). After excluding the study by Wingard et al, the probability of experiencing nephrotoxicity was more similar between the 2 AmB lipid preparations (OR, 1.31; RR, 1.24; n = 916), particularly when the analysis included only the salvage patient population reported by Hachem et al (OR, 1.12; RR, 1.09; n = 839); the 7 remaining studies were more homogenous by Breslow-Day test (p = 0.054).Our results suggest that nephrotoxicity is generally similar for ABLC and L-AmB in patients receiving antifungal therapy and prophylaxis.

Original languageEnglish (US)
Pages (from-to)236-244
Number of pages9
JournalMedicine
Volume89
Issue number4
DOIs
StatePublished - Jul 2010
Externally publishedYes

Fingerprint

Meta-Analysis
Amphotericin B
Odds Ratio
Pharmaceutical Preparations
Lipids
Mycoses
PubMed
MEDLINE
liposomal amphotericin B
Databases
Population
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Safdar, A., Ma, J., Saliba, F., Dupont, B., Wingard, J. R., Hachem, R. Y., ... Raad, I. I. (2010). Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B: A review and meta-analysis. Medicine, 89(4), 236-244. https://doi.org/10.1097/MD.0b013e3181e9441b

Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B : A review and meta-analysis. / Safdar, Amar; Ma, Jonathan; Saliba, Fouzi; Dupont, Bertrand; Wingard, John R.; Hachem, Ray Y.; Mattiuzzi, Gloria N.; Chandrasekar, Pranatharthi H.; Kontoyiannis, Dimitrios P.; Rolston, Kenneth V.; Walsh, Thomas J.; Champlin, Richard E.; Raad, Issam I.

In: Medicine, Vol. 89, No. 4, 07.2010, p. 236-244.

Research output: Contribution to journalArticle

Safdar, A, Ma, J, Saliba, F, Dupont, B, Wingard, JR, Hachem, RY, Mattiuzzi, GN, Chandrasekar, PH, Kontoyiannis, DP, Rolston, KV, Walsh, TJ, Champlin, RE & Raad, II 2010, 'Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B: A review and meta-analysis', Medicine, vol. 89, no. 4, pp. 236-244. https://doi.org/10.1097/MD.0b013e3181e9441b
Safdar, Amar ; Ma, Jonathan ; Saliba, Fouzi ; Dupont, Bertrand ; Wingard, John R. ; Hachem, Ray Y. ; Mattiuzzi, Gloria N. ; Chandrasekar, Pranatharthi H. ; Kontoyiannis, Dimitrios P. ; Rolston, Kenneth V. ; Walsh, Thomas J. ; Champlin, Richard E. ; Raad, Issam I. / Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B : A review and meta-analysis. In: Medicine. 2010 ; Vol. 89, No. 4. pp. 236-244.
@article{231c9781977e41dd8fd5e68479ac100a,
title = "Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B: A review and meta-analysis",
abstract = "Lipid preparations of amphotericin B, commonly used to treat fungal infections, have been demonstrated to have reduced nephrotoxicity compared to conventional amphotericin B. However, to our knowledge, a comprehensive comparison of nephrotoxicity induced by different lipid preparations of amphotericin B has not been performed. We conducted a meta-analysis to evaluate nephrotoxicity associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AmB).We searched the PubMed MEDLINE database and abstracts presented at key scientific meetings, and identified 11 studies reported between 1995 and 2008 that compared nephrotoxicity resulting from the use of these agents. Eight of the 11 studies were included in the meta-analysis. The Cochran-Mantel-Haenszel test was used to determine odds ratio (OR) and relative risk (RR), and the Breslow-Day test was used to analyze homogeneity of ORs across different studies.Analysis of all 8 studies (n = 1160) included in the meta-analysis showed an increased probability of nephrotoxicity in patients treated with ABLC versus L-AmB (OR, 1.75; RR, 1.55), but there was a significant lack of homogeneity across these studies (p <0.001). After excluding the study by Wingard et al, the probability of experiencing nephrotoxicity was more similar between the 2 AmB lipid preparations (OR, 1.31; RR, 1.24; n = 916), particularly when the analysis included only the salvage patient population reported by Hachem et al (OR, 1.12; RR, 1.09; n = 839); the 7 remaining studies were more homogenous by Breslow-Day test (p = 0.054).Our results suggest that nephrotoxicity is generally similar for ABLC and L-AmB in patients receiving antifungal therapy and prophylaxis.",
author = "Amar Safdar and Jonathan Ma and Fouzi Saliba and Bertrand Dupont and Wingard, {John R.} and Hachem, {Ray Y.} and Mattiuzzi, {Gloria N.} and Chandrasekar, {Pranatharthi H.} and Kontoyiannis, {Dimitrios P.} and Rolston, {Kenneth V.} and Walsh, {Thomas J.} and Champlin, {Richard E.} and Raad, {Issam I.}",
year = "2010",
month = "7",
doi = "10.1097/MD.0b013e3181e9441b",
language = "English (US)",
volume = "89",
pages = "236--244",
journal = "Medicine",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Drug-induced nephrotoxicity caused by amphotericin B lipid complex and liposomal amphotericin B

T2 - A review and meta-analysis

AU - Safdar, Amar

AU - Ma, Jonathan

AU - Saliba, Fouzi

AU - Dupont, Bertrand

AU - Wingard, John R.

AU - Hachem, Ray Y.

AU - Mattiuzzi, Gloria N.

AU - Chandrasekar, Pranatharthi H.

AU - Kontoyiannis, Dimitrios P.

AU - Rolston, Kenneth V.

AU - Walsh, Thomas J.

AU - Champlin, Richard E.

AU - Raad, Issam I.

PY - 2010/7

Y1 - 2010/7

N2 - Lipid preparations of amphotericin B, commonly used to treat fungal infections, have been demonstrated to have reduced nephrotoxicity compared to conventional amphotericin B. However, to our knowledge, a comprehensive comparison of nephrotoxicity induced by different lipid preparations of amphotericin B has not been performed. We conducted a meta-analysis to evaluate nephrotoxicity associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AmB).We searched the PubMed MEDLINE database and abstracts presented at key scientific meetings, and identified 11 studies reported between 1995 and 2008 that compared nephrotoxicity resulting from the use of these agents. Eight of the 11 studies were included in the meta-analysis. The Cochran-Mantel-Haenszel test was used to determine odds ratio (OR) and relative risk (RR), and the Breslow-Day test was used to analyze homogeneity of ORs across different studies.Analysis of all 8 studies (n = 1160) included in the meta-analysis showed an increased probability of nephrotoxicity in patients treated with ABLC versus L-AmB (OR, 1.75; RR, 1.55), but there was a significant lack of homogeneity across these studies (p <0.001). After excluding the study by Wingard et al, the probability of experiencing nephrotoxicity was more similar between the 2 AmB lipid preparations (OR, 1.31; RR, 1.24; n = 916), particularly when the analysis included only the salvage patient population reported by Hachem et al (OR, 1.12; RR, 1.09; n = 839); the 7 remaining studies were more homogenous by Breslow-Day test (p = 0.054).Our results suggest that nephrotoxicity is generally similar for ABLC and L-AmB in patients receiving antifungal therapy and prophylaxis.

AB - Lipid preparations of amphotericin B, commonly used to treat fungal infections, have been demonstrated to have reduced nephrotoxicity compared to conventional amphotericin B. However, to our knowledge, a comprehensive comparison of nephrotoxicity induced by different lipid preparations of amphotericin B has not been performed. We conducted a meta-analysis to evaluate nephrotoxicity associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AmB).We searched the PubMed MEDLINE database and abstracts presented at key scientific meetings, and identified 11 studies reported between 1995 and 2008 that compared nephrotoxicity resulting from the use of these agents. Eight of the 11 studies were included in the meta-analysis. The Cochran-Mantel-Haenszel test was used to determine odds ratio (OR) and relative risk (RR), and the Breslow-Day test was used to analyze homogeneity of ORs across different studies.Analysis of all 8 studies (n = 1160) included in the meta-analysis showed an increased probability of nephrotoxicity in patients treated with ABLC versus L-AmB (OR, 1.75; RR, 1.55), but there was a significant lack of homogeneity across these studies (p <0.001). After excluding the study by Wingard et al, the probability of experiencing nephrotoxicity was more similar between the 2 AmB lipid preparations (OR, 1.31; RR, 1.24; n = 916), particularly when the analysis included only the salvage patient population reported by Hachem et al (OR, 1.12; RR, 1.09; n = 839); the 7 remaining studies were more homogenous by Breslow-Day test (p = 0.054).Our results suggest that nephrotoxicity is generally similar for ABLC and L-AmB in patients receiving antifungal therapy and prophylaxis.

UR - http://www.scopus.com/inward/record.url?scp=77954751954&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954751954&partnerID=8YFLogxK

U2 - 10.1097/MD.0b013e3181e9441b

DO - 10.1097/MD.0b013e3181e9441b

M3 - Article

VL - 89

SP - 236

EP - 244

JO - Medicine

JF - Medicine

SN - 0025-7974

IS - 4

ER -