Outcomes associated with conventional versus lipid-based formulations of amphotericin B in propensity-matched groups

Outcomes associated with conventional versus lipid-based formulations of amphotericin B in propensity-matched groups

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Rebecca S Campbell,1 Paresh Chaudhari,2 Harlen D Hays,1 Robert J Taylor,1 Brian H Nathanson,3 Samuel A Bozzette,1 David Horn4 1Cerner Research, Culver City, CA, USA; 2Astellas Scientific and Medical Affairs, Inc., Northbrook, IL, USA; 3OptiStatim, LLC, Longmeadow, MA, USA; 4David Horn LLC, Doylestown, PA, USA Background: Lipid-based formulations of amphotericin B (LF-AMB) are indicated for treatment of invasive fungal infections in patients intolerant to conventional amphotericin B (CAB) or with refractory infections.Physicians still may choose to administer CAB to such patients.We described the use of CAB and LF-AMB in this population and quantified differences in post-amphotericin B length of stay (LOS) among survivors and hospital The Border South mortality in matched patients.Methods: Data were extracted from Health Facts (Cerner Corporation, Kansas City, MO, USA) for a retrospective cohort analysis.

Inpatients aged ≥18 years with evidence of fungal infection and with orders for LF-AMB or CAB on  ≥2 days from January 2001 to June 2010 were identified.Patients were required to have renal insufficiency or other relative contraindications to use of CAB, exposure to nephrotoxic agents, or evidence of a CAB-refractory infection.Multilevel (hierarchical) mixed-effects logistic regression was used to determine factors associated with initial exposure to LF-AMB versus CAB.Multivariate adjustment of outcomes was done using propensity score matching.Results: 655 patients were identified: 322 patients initiated therapy with CAB and 333 initiated treatment with LF-AMB.

Compared to those initiating CAB, patients initiating LF-AMB had greater acuity and underlying disease severity.In unadjusted analyses, hospital mortality was significantly higher in the LF-AMB group (32.2% versus 23.7%; P = 0.02).

After propensity score matching and covariate adjustment, mortality equalized and observed differences in LOS after amphotericin B initiation decreased.Conclusion: Among patients at risk for amphotericin B toxicity, differences between CAB and LF-AMB seen in crude outcomes analyses relate to channeling of sicker patients to initiate treatment with LF-AMB.Failing to account for differences among patients that drive clinical decision-making will result in inaccurate conclusions about the real-world effectiveness of different amphotericin The Advances of Single-Cell RNA-Seq in Kidney Immunology B formulations.Keywords: amphotericin, outcomes, mortality, hospitalization.