Johansen, H.K., & Gotzsche, P.C. (2000). Amphotericin B lipid soluble formulations vs amphotericin B in cancer patients with neutropenia. Cochrane Database of Systematic Reviews, 3, CD000969.

The article evaluated lipid-soluble formulations of amphotericin B compared with conventional amphotericin B.

The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed (through November 2007) databases were searched, as were the proceedings from the Interscience Conference on Antimicrobial Agents and Chemotherapy (1990–2007), the General Meeting of the American Society of Microbiology (1990–2007), and European Congress of Clinical Microbiology and Infectious Diseases (1995–2007). In addition, the reference lists of articles were searched, and researchers in the field were contacted.

12 randomized trials

• 1,895 neutropenic patients with cancer.
• Most patients had acute leukemia or were undergoing hematopoietic stem cell transplantation (HSCT).

• Lipid-based amphotericin B was not more effective than conventional amphotericin B for mortality.
• Lipid-based amphotericin B decreased invasive fungal infections by 35%.
• Lipid-based amphotericin B decreased nephrotoxicity by 55%.
• Lipid-based amphotericin B decreased dropouts from the study by 22%.

There was no significant difference in mortality for the drug used in most patients, AmBisome (three trials, 1,149 patients), whereas it tended to be more effective than conventional amphotericin B for invasive fungal infection (RR = 0.63, 0.39 to 1.01, p = 0.053).

Despite a significant reduction in invasive fungal infections and nephrotoxicity seen with lipid-based amphotericin B formulations, the authors concluded that an advantage was unclear regarding the use of lipid-based amphotericin B formulations if conventional amphotericin B is administered under optimal circumstances.

In the trials reviewed, amphotericin B rarely was administered under optimal circumstances (routine premedication for the prevention of infusion-related toxicity and supplementation with fluid, potassium, and magnesium for the prevention of nephrotoxicity).