Abstract：
Allergic bronchopulmonary aspergillosis (ABPA) is complicated by exacerbations in more than one-third of the subjects. Whether nebulized amphotericin B (NAB) therapy prevents ABPA exacerbations remains unclear.
The primary objective of this systematic review and meta-analysis was to determine the frequency of subjects remaining exacerbation-free, one year after initiating NAB. The key secondary objectives were the time to first exacerbation and the safety of NAB therapy.
We searched the PubMed and Embase databases for studies evaluating ≥5 subjects of ABPA managed with NAB. We report the pooled proportion of ABPA subjects remaining exacerbation free after one year. For the randomized controlled trials (RCTs), we estimate the pooled risk difference (RD) of exacerbation-free status at one year with NAB versus the control arm.
We included five studies for our analysis; three were observational (n = 28) and two RCTs (n = 160). The pooled proportion (95% confidence interval [CI]) of subjects remaining exacerbation free with NAB at one year was 76% (62-88). The pooled RD (95% CI) of an exacerbation-free status at one year was 0.33 (-0.12 to 0.78) and was not significantly different between the NAB and control arms. The time to first exacerbation was longer with NAB than with the standard therapy. No serious adverse events were reported with NAB.
NAB does not improve exacerbation-free status at one year; however, weak evidence suggests it delays ABPA exacerbations. More research using different dosing regimens is required.
The primary objective of this systematic review and meta-analysis was to determine the frequency of subjects remaining exacerbation-free, one year after initiating NAB. The key secondary objectives were the time to first exacerbation and the safety of NAB therapy.
We searched the PubMed and Embase databases for studies evaluating ≥5 subjects of ABPA managed with NAB. We report the pooled proportion of ABPA subjects remaining exacerbation free after one year. For the randomized controlled trials (RCTs), we estimate the pooled risk difference (RD) of exacerbation-free status at one year with NAB versus the control arm.
We included five studies for our analysis; three were observational (n = 28) and two RCTs (n = 160). The pooled proportion (95% confidence interval [CI]) of subjects remaining exacerbation free with NAB at one year was 76% (62-88). The pooled RD (95% CI) of an exacerbation-free status at one year was 0.33 (-0.12 to 0.78) and was not significantly different between the NAB and control arms. The time to first exacerbation was longer with NAB than with the standard therapy. No serious adverse events were reported with NAB.
NAB does not improve exacerbation-free status at one year; however, weak evidence suggests it delays ABPA exacerbations. More research using different dosing regimens is required.
摘要：
背景：过敏性支气管肺曲霉病（ABPA）因超过三分之一的受试者的恶化而复杂化。两性霉素B（NAB）雾化治疗是否可以预防ABPA恶化尚不清楚。
目的：本系统评价和荟萃分析的主要目的是确定受试者保持无加重的频率，启动NAB一年后。关键的次要目标是首次加重的时间和NAB治疗的安全性。
方法：我们在PubMed和Embase数据库中搜索了评估NAB管理的≥5名ABPA受试者的研究。我们报告了一年后保持无恶化的ABPA受试者的合并比例。对于随机对照试验(RCT)，我们估计NAB与对照组1年无加重状态的合并风险差异(RD).
结果：我们纳入了5项研究，其中3项是观察性的（n=28），2项RCT（n=160）。在NAB一年内保持无恶化的受试者的合并比例(95%置信区间[CI])为76%(62-88)。一年无加重状态的合并RD（95％CI）为0.33（-0.12至0.78），NAB和对照组之间没有显着差异。NAB首次加重的时间比标准疗法更长。NAB未报告严重不良事件。
结论：NAB不会改善一年的无加重状态；然而，微弱的证据表明它延迟了ABPA的恶化。需要使用不同给药方案的更多研究。
目的：本系统评价和荟萃分析的主要目的是确定受试者保持无加重的频率，启动NAB一年后。关键的次要目标是首次加重的时间和NAB治疗的安全性。
方法：我们在PubMed和Embase数据库中搜索了评估NAB管理的≥5名ABPA受试者的研究。我们报告了一年后保持无恶化的ABPA受试者的合并比例。对于随机对照试验(RCT)，我们估计NAB与对照组1年无加重状态的合并风险差异(RD).
结果：我们纳入了5项研究，其中3项是观察性的（n=28），2项RCT（n=160）。在NAB一年内保持无恶化的受试者的合并比例(95%置信区间[CI])为76%(62-88)。一年无加重状态的合并RD（95％CI）为0.33（-0.12至0.78），NAB和对照组之间没有显着差异。NAB首次加重的时间比标准疗法更长。NAB未报告严重不良事件。
结论：NAB不会改善一年的无加重状态；然而，微弱的证据表明它延迟了ABPA的恶化。需要使用不同给药方案的更多研究。
