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Effectiveness of voriconazole in the treatment of Aspergillus fumigatus–associated asthma (EVITA3 study)

Authors
Journal
Journal of Allergy and Clinical Immunology
0091-6749
Publisher
Elsevier
Volume
134
Issue
1
Identifiers
DOI: 10.1016/j.jaci.2013.09.050
Keywords
  • Refractory
  • Asthma
  • Exacerbations
  • Aspergillus Fumigatus
  • Allergic Bronchopulmonary Aspergillosis
  • Mold
  • Eosinophils
  • Voriconazole
  • Quality Of Life
  • Severe Asthma With Fungal Sensitization
Disciplines
  • Design
  • Medicine

Abstract

Background IgE sensitization to Aspergillus fumigatus and a positive sputum fungal culture result are common in patients with refractory asthma. It is not clear whether these patients would benefit from antifungal treatment. Objectives We sought to determine whether a 3-month course of voriconazole improved asthma-related outcomes in patients with asthma who are IgE sensitized to A fumigatus. Methods Asthmatic patients who were IgE sensitized to A fumigatus with a history of at least 2 severe exacerbations in the previous 12 months were treated for 3 months with 200 mg of voriconazole twice daily, followed by observation for 9 months, in a double-blind, placebo-controlled, randomized design. Primary outcomes were improvement in quality of life at the end of the treatment period and a reduction in the number of severe exacerbations over the 12 months of the study. Results Sixty-five patients were randomized. Fifty-nine patients started treatment (32 receiving voriconazole and 27 receiving placebo) and were included in an intention-to-treat analysis. Fifty-six patients took the full 3 months of medication. Between the voriconazole and placebo groups, there were no significant differences in the number of severe exacerbations (1.16 vs 1.41 per patient per year, respectively; mean difference, 0.25; 95% CI, 0.19-0.31), quality of life (change in Asthma Quality of Life Questionnaire score, 0.68 vs 0.88; mean difference between groups, 0.2; 95% CI, −0.05 to −0.11), or any of our secondary outcome measures. Conclusion We were unable to show a beneficial effect of 3 months of treatment with voriconazole in patients with moderate-to-severe asthma who were IgE sensitized to A fumigatus on either the rate of severe exacerbations, quality of life, or other markers of asthma control.

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