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Effectiveness of itraconazole and systemic steroids in the treatment of ABPA

Background: Systemic steroids are the cornerstone of therapy in allergic bronchopulmonary aspergillosis(ABPA) but are associated with adverse effects. Itraconazole(ITZ) is proposed as an effective yet safer alternative. Aims: To evaluate the effectiveness of ITZ in comparison to systemic steroids in the management of ABPA. Methods: ABPA patients diagnosed between 2010-16 were administered oral ITZ or deflazacort(DFZ) and were followed every 3 months with serial total and specific IgE antibodies, chest x-ray; symptom control, time to remission, exacerbations and time to exacerbations were noted. Results: 172 patients were enrolled, 45 received ITZ(group A) and 106 received DFZ(group B). Both groups were homogenous with regards to their baseline characteristics (P 0.9999) achieved remissions and at a similar time (7.7±0.7 vs 7.5±0.4months respectively;P=0.77). Also, an equal number exacerbated (57.5 vs 51.7% respectively;P=0.57) within 6 months (4.4±0.7 vs 5.7±0.5 respectively;P=0.13) after stopping therapy. However patients in group A suffered more exacerbations (1.2±0.1 vs 1.05±0.03months;P=0.048) subsequently. Conclusions: ITZ and DFZ are equally effective in ABPA when administered for a similar duration to effect a disease remission. While neither drug is superior in preventing or delaying exacerbations of the disease, steroids may have the advantage of producing lesser subsequent exacerbations in comparison to ITZ.