CCATES

Amphotericin B formulations for the treatment of fungal infections in patients with HIV / AIDS – Brazilian context

PTC 07/2012

DOI: 10.13140/2.1.3943.2484

 

Autores: Juliana de Oliveira Costa, Lívia Lovato Pires de Lemos, Rosângela Maria Gomes, Augusto Afonso Guerra Júnior, Francisco de Assis Acurcio

EXECUTIVE ABSTRACT

Strength of Recommendations: Weak in favor of liposomal amphotericin B.

Technology: Liposomal amphotericin B and amphotericin B lipid complex.

Indication: Fungal infections.

Characterization of the technology: Polienic antibiotic that binds to the steroid present in the cell membrane of fungi, resulting in a change in membrane permeability and cell death.

Question: Which of lipid formulations of amphotericin B is more cost-effective for the treatment of systemic fungal infections in patients with HIV/AIDS?

Search and analysis of scientific evidence: We searched The Cochrane Library, Centre for Reviews and Dissemination, Tripdatabase, Medline and LILACS databases. We included studies comparing different formulations of amphotericin B. We searched Health Technology Assessments (HTA) from sites of national and international agencies.

Summary of results of selected studies: We selected five systematic reviews, one specifically designed to evaluate the safety of medicines. In general there were no statistically significant differences in terms of survival, response to treatment. However, there were differences regarding safety. The liposomal amphotericin B was associated with a lower risk of nephrotoxicity and increased serum creatinine. We included two economic studies, a cost- minimization and cost-effectiveness analysis. The results were conflicting; the first favored the lipid complex formulation and the second the liposomal formulation. Both studies showed significant limitations and there is no study considering the Brazilian context.

Recommendations: Considering all the studies found, as well as their limitations, we do not recommended the use of liposomal amphotericin B in patients with HIV/AIDS affected by fungal infections, unless strictly in cases where patients have abnormal renal function. Also, liposomal amphotericin B could be used in case of intolerance to conventional amphotericin B.

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