
ABSTRACT Amphotericin B is a first-line agent for the treatment of invasive aspergillosis. However, relatively little is known about the pharmacodynamics of amphotericin B for invasive pulmonary aspergillosis. We studied the pharmacokinetics (PK) and pharmacodynamics (PD) of amphotericin B deoxycholate (DAMB), amphotericin B lipid complex (ABLC), and liposomal amphotericin B (LAMB) by using a neutropenic-rabbit model of invasive pulmonary aspergillosis. The study endpoints were lung weight, infarct score, and levels of circulating galactomannan and (1→3)-β- d -glucan. Mathematical models were used to describe PK-PD relationships. The experimental findings were bridged to humans by Monte Carlo simulation. Each amphotericin B formulation induced a dose-dependent decline in study endpoints. Near-maximal antifungal activity was evident with DAMB at 1 mg/kg/day and ABLC and LAMB at 5 mg/kg/day. The bridging study suggested that the “average” patient receiving LAMB at 3 mg/kg/day was predicted to have complete suppression of galactomannan and (1→3)-β- d -glucan levels, but 20 to 30% of the patients still had a galactomannan index of >1 and (1→3)-β- d -glucan levels of >60 pg/ml. All formulations of amphotericin B induce a dose-dependent reduction in markers of lung injury and circulating fungus-related biomarkers. A clinical dosage of liposomal amphotericin B of 3 mg/kg/day is predicted to cause complete suppression of galactomannan and (1→3)-β- d -glucan levels in the majority of patients.
Invasive Pulmonary Aspergillosis, Antifungal Agents, Aspergillus fumigatus, Models, Theoretical, Drug Combinations, Amphotericin B, Animals, Rabbits, Monte Carlo Method, Deoxycholic Acid
Invasive Pulmonary Aspergillosis, Antifungal Agents, Aspergillus fumigatus, Models, Theoretical, Drug Combinations, Amphotericin B, Animals, Rabbits, Monte Carlo Method, Deoxycholic Acid
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