EVITA+revised+unmkd.pdf (358.17 kB)
Effectiveness of voriconazole in the treatment of Aspergillus fumigatus-associated asthma (EVITA3 study).
journal contributionposted on 2019-10-01, 13:41 authored by J Agbetile, M Bourne, A Fairs, B Hargadon, D Desai, C Broad, J Morley, P Bradding, CE Brightling, RH Green, P Haldar, CH Pashley, ID Pavord, AJ Wardlaw
BACKGROUND: IgE sensitization to Aspergillus fumigatus and a positive sputum fungal culture result are common in patients with refractory asthma. It is not clear whether these patients would benefit from antifungal treatment. OBJECTIVES: We sought to determine whether a 3-month course of voriconazole improved asthma-related outcomes in patients with asthma who are IgE sensitized to A fumigatus. METHODS: Asthmatic patients who were IgE sensitized to A fumigatus with a history of at least 2 severe exacerbations in the previous 12 months were treated for 3 months with 200 mg of voriconazole twice daily, followed by observation for 9 months, in a double-blind, placebo-controlled, randomized design. Primary outcomes were improvement in quality of life at the end of the treatment period and a reduction in the number of severe exacerbations over the 12 months of the study. RESULTS: Sixty-five patients were randomized. Fifty-nine patients started treatment (32 receiving voriconazole and 27 receiving placebo) and were included in an intention-to-treat analysis. Fifty-six patients took the full 3 months of medication. Between the voriconazole and placebo groups, there were no significant differences in the number of severe exacerbations (1.16 vs 1.41 per patient per year, respectively; mean difference, 0.25; 95% CI, 0.19-0.31), quality of life (change in Asthma Quality of Life Questionnaire score, 0.68 vs 0.88; mean difference between groups, 0.2; 95% CI, -0.05 to -0.11), or any of our secondary outcome measures. CONCLUSION: We were unable to show a beneficial effect of 3 months of treatment with voriconazole in patients with moderate-to-severe asthma who were IgE sensitized to A fumigatus on either the rate of severe exacerbations, quality of life, or other markers of asthma control.
Supported by Pfizer and the National Institute for Health Research (NIHR) Leicester Respiratory Biomedical Research Unit.
CitationJournal of Allergy and Clinical Immunology, 2014, 134 (1), pp. 33-39
Author affiliation/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation
- AM (Accepted Manuscript)
Published inJournal of Allergy and Clinical Immunology
PublisherElsevier for American Academy of Allergy, Asthma and Immunology, Mosby
Aspergillus fumigatusRefractoryallergic bronchopulmonary aspergillosisasthmaeosinophilsexacerbationsmoldquality of lifesevere asthma with fungal sensitizationvoriconazoleAdultAgedAged, 80 and overAntifungal AgentsAspergillosisAsthmaDouble-Blind MethodDrug Administration ScheduleFemaleHumansImmunoglobulin EIntention to Treat AnalysisMaleMiddle AgedQuality of LifeSeverity of Illness IndexSurveys and QuestionnairesTreatment OutcomeVoriconazole