Safety and Efficacy of Liposomal Amphotericin B as Empirical Therapy in Invasive Fungal Diseases: A Narrative Review

Invasive Fungal Diseases (IFDs) have been considered a critical cause of morbidity and mortality among patients with febrile neutropenia receiving hematopoietic stem cell transplant and/or chemotherapy for cancer treatment. Toxicity concerns and adverse events are significant challenges associated with administering conventional Amphotericin B (c-AmB). Therefore, lipid and liposomal formulations of amphotericin B are effective, well-tolerated and remain the standard of care in treating IFDs. These formulations are reported to exhibit a broad antifungal spectrum, low resistance and reduced toxicity. Empirical therapy with Liposomal Amphotericin B (L-AmB) has been found to enhance efficacy and lower toxicity and is recommended in neutropenic patients with different conditions like cancer and transplant. Additionally, L-AmB has demonstrated better efficacy and safety as compared to other antifungal agents like caspofungin, amphotericin B lipid complex and c-AmB, thus providing an added advantage over these agents.

Currently, studies published in the literature mostly focus on the efficacy of L-AmB for a single clinical condition. In most published studies, L-AmB has been administered in combination with other antifungal agents (either empirically or prophylactically). Moreover, studies exclusively focusing on the benefit of empirical therapy with L-AmB for treating IFD in patients with various conditions are not available. Therefore, this review collates and highlights the efficacy and safety of LAmB exclusively as empirical therapy in treating IFD in patients with conditions including cancer and transplant patients with neutropenia.