A Cochrane review [Abstract] 1 included 3 studies with a total of 94 subjects with allergic bronchopulmonary aspergillosis. One study demonstrated a reduction in immunological markers of disease activity and symptom scores using ketoconazole 400 mg daily for 12 months. There was no significant improvement in lung function. The other two examined the use of itraconazole for 16 weeks. In one there was a reduction in sputum eosinophils by 35% compared to 19% with placebo (p < 0.01). In the same trial, the number of exacerbations requiring oral corticosteroids was 0.4 per patient with itraconazole compared with 1.3 per patient with placebo (p < 0.03). Meta-analysis of data from both trials showed that itraconazole treated patients were more likely to have decline in serum IgE over 25% or more (Peto OR 3.30; 95% CI 1.30 to 8.15). The capacity of itraconazole, in combination with inhaled corticosteroids, to induce adrenal suppression is an important potential adverse effect.
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).
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