Clinical Trial: Monotherapy of Itraconazole Versus Prednisolone in Allergic Bronchopulmonary Aspergillosis

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title:

Brief Summary: The purpose of this study is to evaluate the efficacy and safety of itraconazole monotherapy in patients with ABPA.

Detailed Summary:

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder caused by a complex hypersensitivity response to antigens released by the fungus Aspergillus fumigatus. The clinical entity was first described by Hinson et al in 1952, and the clinical and immunologic significance of Aspergillus fumigatus in the sputum were reported by Pepys and coworkers in 1959. The prevalence of ABPA in bronchial asthma is fairly high and a recent meta-analysis suggested the prevalence of ABPA in asthma clinics to be as high as 13 percent. Diagnostic criteria for ABPA have been laid and generally include the following eight major criteria: (a) history of asthma; (b) transient or fixed pulmonary infiltrates; (c) immediate cutaneous hyperreactivity to A fumigatus antigen; (d) absolute eosinophil count > 1000/µL; (e) serum precipitins against A fumigatus; (f) total IgE levels > 1000 IU/mL; (g) central bronchiectasis on high-resolution computed tomography (HRCT); and, (h) raised A fumigatus specific IgE or IgG levels. However, none of these are specific for ABPA,and there is still no consensus on the number of criteria needed for diagnosis, and patients in different stages of ABPA may not fulfill all these criteria. Also, there is no established definition for remission of ABPA. The most widely followed criteria are clinical and radiological improvement with at least 35 percent decline in total serum IgE levels. However, in a recent study the investigators demonstrated that a 35% decline in serum IgE levels at six weeks is not seen in all patients with ABPA, and the decline is slower in patients with baseline IgE levels < 2500 IU/mL. Moreover, the quantum decline in serum IgE levels did not predict clinical outcome. The disorder is highly prevalent in India. The investigators have previously reported our experience with screening stable outpatients with bronchial asthma and acute severe asthma for ABPA. The investigators
Sponsor: Postgraduate Institute of Medical Education and Research

Current Primary Outcome:

  • Remission rates in the two groups at six weeks and three months [ Time Frame: 6 weeks, 3 months ]
    Remission - if the IgE levels decline by >=25% and there is clinical improvement with partial/total clearance of chest radiographic lesions after three months of glucocorticoids (if previously present pulmonary opacities)
  • Percentage decline in IgE levels at six weeks and three months [ Time Frame: 6 weeks, 3 months ]
    IgE levels will be noted at baseline six weeks and three months after glucocorticoid therapy and percentage decline will be calculated as: (baseline IgE levels minus IgE levels after six weeks of treatment) divided by baseline IgE levels
  • Complete remission rates in the two groups [ Time Frame: 3 months, 6 months ]
    No ABPA exacerbations over the next 3 months after stopping therapy


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Relapse rates in the two groups at six and 12 months after completion of treatment [ Time Frame: 6 months, 12 months ]
    Relapse - doubling of the baseline IgE levels irrespective of the patient's symptoms or appearance of radiologic infiltrates
  • Treatment related adverse effects in the two groups [ Time Frame: Every 6 weeks ]


Original Secondary Outcome: Same as current

Information By: Postgraduate Institute of Medical Education and Research

Dates:
Date Received: March 23, 2011
Date Started: April 2011
Date Completion:
Last Updated: March 15, 2017
Last Verified: March 2017