Comparative Efficacy of Amphotericin B Lipid Complex and Liposomal Amphotericin B for the Treatment of Invasive Fungal Infections in HSCT Recipients and other Immunocompromised Patient Populations with Hematologic Malignancies: A Critical Review

Amphotericin B is an important agent for the treatment of invasive fungal infections in immunocompromised patients because of its broad spectrum. However, its toxicities and the availability of alternative agents limit its application. Lipid-based formulations of amphotericin B, such as amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB), are less nephrotoxic and as effective as conventional amphotericin B. However, because of their similarities, choosing between the two formulations remains a challenge. The majority of prospective and retrospective comparative studies have shown equivalence in terms of efficacy although some subset analyses favor ABLC over L-AMB. While both drugs penetrate well in the reticuloendothelial system, ABLC gets concentrated in the lungs to a much greater extent. This may have clinical implications because the lungs are the commonest site of invasive fungal infections. L-AMB is associated with less infusion-related adverse effects and less nephrotoxicity than ABLC. ABLC has been shown to be more cost-effective than L-AMB, although this is affected by variable institutional contracts and pricing. The choice between the two drugs should be based upon due consideration of all these factors.