Mortality rates in comparative trials of formulations of amphotericin B.

Abstract

Sir—Wingard et al. [1] reported a randomized controlled trial of the use of amphotericin B lipid complex (ABLC; Abelcet [The Liposome Company]) versus liposomal amphotericin B (L Amph; AmBisome [Fujisawa Healthcare]) for the empirical treatment of patients with febrile neutropenia that is unresponsive to antibacterial therapy. Subjects were randomized to receive ABLC, 5 mg/kg/day; L Amph, 3 mg/kg/day; or L Amph, 5 mg/kg/day. ABLC had greater toxicity according to 4 measures: fever, chill/rigors, nephrotoxicity, and toxicity-related discontinuation of therapy. The composite end point of successful response was similar for the 3 treatment groups (table 1). Mortality rates were briefly mentioned but were not discussed at length in the article or the accompanying editorial [1, 2].