Treat promptly, treat broad

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I am... effective against a broad spectrum of fungal pathogens including rare and resistant species1-5

AmBisome® has improved fungicidal activity against the most clinically important yeasts and moulds vs. echinocandins and azoles.2,4,6

Fungicidal activity is particularly important for immunocompromised patients, as their immune systems may not be able to eliminate fungal pathogens alongside a fungistatic agent.7

Use the tabs below to discover more about the activity of different types of antifungal therapy

Candida Spp.

  • Candida albicans2
  • Candida glabrata2
  • Candida krusei2
  • Candida parapsilosis2
  • Candida tropicalis2
  • Candida lusitaniae2

Aspergillus Spp.

  • Aspergillus fumigatus6
  • Aspergillus flavus6
  • Aspergillus terreus6

Other important Spp.

  • Mucorales1
  • Cryptococcus neoformans2
  • Histoplasma capsulatum8
  • Fusarium spp.1
KEY
  • Fungicidal activity
  • Fungistatic activity
  • No activity

Echinocandins

Echinocandins are fungicidal against Candida but only fungistatic against Aspergillus4

Azoles

Azoles are fungistatic in most cases9

AmBisome® has a broad spectrum of activity against most fungal pathogens, including those causing rare and difficult to treat infections.2-5

Scroll down to discover more about the life-threatening IFIs caused by both common and rare fungal pathogens

I Am... effective in patients with invasive candidiasis10

In a non-inferiority study (n=531), AmBisome® (3 mg/kg/day) demonstrated efficacy as a 1st-line therapy for proven invasive candidiasis (IC) or candidaemia in patients with a variety of underlying conditions, including haematological disorders and neutropenia.*

Fungal infection was considered to contribute to the cause of death in 9% and 13% of patients in the AmBisome® (n=25) and micafungin (n=34) groups, respectively (p=0.22).10

Treatment success rates** for AmBisome® vs. micafungin in patients with confirmed IC or candidaemia10

KEY
  • AmBisome®
  • Micafungin

Patients with proven invasive candidiasis or candidaemia

AmBisome® 89.5%
89.5% (n=190)
Vs.

Respectively, for micafungin10

Micafungin 89.6%
89.6% (n=202)

Patients with neutropenia at baseline

AmBisome® 89.5%
80.0% (n=15)
Vs.

Respectively, for micafungin10

Micafungin 75.0%
75% (n=24)

*Double-blind, randomised (1:1), non-inferiority study in 531 adults (≥16 years) with confirmed IC or candidaemia comparing 1st-line treatment with AmBisome® (3 mg/kg/day) or micafungin (100 mg/day for patients weighing >40 kg, and 2 mg/kg/day for those weighing <40 kg). After 12 weeks, 40% of patients in both the AmBisome® group (n=108) and micafungin group (n=106) had died. Fungal infection was considered to contribute to the cause of death in 9% and 13% of patients in the AmBisome® (n=25) and micafungin (n=34) groups, respectively (p=0.22).10

**Complete or partial cure plus microbiological eradication or presumed eradication.10

I Am… effective in patients with invasive aspergillosis11

In a 2007 study, a retrospective analysis found that after 12 weeks the rate of survival in patients with proven (microbiological-confirmed) or probable (based solely on the presence of a halo sign) invasive aspergillosis (IA) treated with AmBisome® (3 mg/kg/day) (n=107) was 72%.†11

Rate of survival after AmBisome® treatment (3mg/kg/day)11

Probability of survival graph

†Double-blind study in 339 immunocompromised adults and children (>30 days old) with proven or probable IA or other mould infections (EORTC/MSG criteria) who were randomised (1:1) to receive 1st-line therapy with AmBisome® either at 3 mg/kg/day (standard dose) or 10 mg/kg/day for 14 days (high-loading dose), followed by 3 mg/kg per day. The primary objective of the trial was to compare the favourable (i.e., complete or partial) response of the high-loading dose with the standard dose of AmBisome® in the modified intent-to-treat population at the end of the study treatment regimen. Secondary end points included survival up to 12 weeks and the safety profiles of the treatment regimens.11

Keep scrolling to discover how AmBisome® can help combat the emerging threat of rare and difficult-to-treat infections

I Am… EFFECTIVE IN PATIENTS WITH MUCORMYCOSIS12,13

In a prospective, multicentre pilot study for the treatment of proven or probable mucormycosis, a combination of high-dose AmBisome® (10 mg/kg/day) and surgery was associated with an overall response rate of 36% (12/33 patients) at week 4 and 45% (14/31 patients) at week 12.‡12

In a retrospective study (n=70), the timely initiation (within 6 days of diagnosis) of amphotericin B, the active ingredient in AmBisome®, significantly reduced mortality in patients with haematologic malignancies with definite or probable mucormycosis vs. delayed treatment.13

Mortality rates at 4 weeks and 12 weeks after timely vs. delayed initiation of treatment13

KEY
  • Mortality rate at 4 weeks (p=0.006)
  • Mortality rate at 12 weeks (p=0.03)
Mortality rates (%)
100 80 60 40 20 0
35.1%
48.6%

Early treatment

66.1%
82.9%

Delayed treatment

‡Prospective, multicentre pilot study in 40 patients with proven or probable mucormycosis (June 2007 to July 2011). Patients were scheduled to receive 10 mg/kg/day liposomal amphotericin B (L-AMB) monotherapy for 1 month and surgery was performed when appropriate. The primary outcome was response rate at week 4 or at the end of treatment if before week 4, evaluated by an independent committee. Secondary end points included treatment efficacy at 12 weeks.12 The recommended starting dose to treat mucormycosis is 5 mg/kg. Although doses greater than 5 mg/kg and up to a maximum of 10 mg/kg have been used in clinical trials and clinical practice, data on the safety and efficacy of AmBisome® for the treatment of mucormycosis at these higher doses are limited.14

Retrospective study of 70 consecutive patients with haematologic malignancies who had definite or probable mucormycosis from January 1989 to April 2006 and who had received initial treatment with amphotericin B. Results were analysed to determine the impact of delaying effective amphotericin B-based therapy, compared with other clinical predictors of outcome among patients with mucormycosis. Given the challenges of clinically distinguishing mucormycosis from aspergillosis, timely initiation of amphotericin B was recommended. Delayed treatment was defined as ≥6 days after diagnosis; early treatment was defined as <6 days after diagnosis.13

I Am… effective in patients with AIDS‑related histoplasmosis15-17

AmBisome® is a treatment of choice for central nervous system (CNS) histoplasmosis, with demonstrated improved survival (10.6 months) for patients compared with amphotericin B lipid complex (8.3 months) (p=0.040).17

In a comparison between two separate closed clinical trials, AmBisome® (3 mg/kg/day) was found to clear the fungal burden of disseminated histoplasmosis in patients with AIDS faster than itraconazole.15

Percentage of patients with negative Histoplasma blood cultures after 2 weeks of treatment with AmBisome® (3 mg/kg/day) vs Itraconazole¥15

KEY
  • AmBisome®
  • Itraconazole
AmBisome® 85.0%
of AmBisome® patients with histoplasmosis (n=51)
Vs.
Itraconazole 53.0%
of itraconazole patients with histoplasmosis (n=59; p=0.0008)15

¥Two separate closed clinical trials that evaluated the efficacy of AmBisome® and itraconazole in the treatment of disseminated histoplasmosis in patients with AIDS. Blood was cultured for fungus and blood and urine were tested for Histoplasma antigen. In the itraconazole study, the loading dose was 300 mg by mouth twice daily for 3 days and then 200 mg twice daily for 12 weeks. Patients were evaluated for clinical response weekly for the first 4 weeks, biweekly for the next 4 weeks, and then at the completion of induction at 12 weeks. Fungal blood cultures were done at the local institution at weeks 0, 1, 2, 4, 8, and 12. In the AmBisome® study, patients were randomised 2:1 to receive AmBisome® at 3 mg/kg/day or deoxycholate amphotericin B at 0.7 mg/kg/day for 2 weeks, followed by itraconazole at 200 mg twice daily for another 10 weeks. For this report, since clearance of positive cultures and antigen were similar in the AmBisome® and deoxycholate amphotericin B arms but fewer patients were available in the deoxycholate amphotericin B group, only the AmBisome® group is compared to itraconazole group.15

Stay one step ahead of IFIs in your at-risk patients with AmBisome®'s broad-spectrum fungicidal activity and proven clinical efficacy1,2,4,6,8,10,11,15-19

Dive into more data with our interactive gallery

View the gallery

AIDS: Acquired immune deficiency syndrome; ART: Antiretroviral therapy; EORTC/MSG: European Organisation for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group; HIV: Human immunodeficiency virus; IA: Invasive aspergillosis; IC: Invasive candidaemia; ITT: Intention-to-treat; WHO: World Health Organisation.

References:

  1. Nett JE and Andes DR. Infect Dis Clin North Am. 2016;30:51–83.
  2. Lass-Flörl C et al. Antimicrob Agents Chemother. 2008;52(10):3637–3641.
  3. Almyroudis NG et al. Antimicrob Agents Chemother. 2007;51(7):2587–2590.
  4. Chandrasekar P. J Antimicrob Chemother. 2011;66(3):457–465.
  5. Manavathu M et al. J Antimicrob Chemother. 1998;42(11):3018–3021.
  6. Meletiadis J et al. J Antimicrob Agents Chemother. 2007;51(9):3329–3337.
  7. Graybill JR et al. Eur J Clin Microbiol Infect Dis. 1997;16:
  8. Li RK et al. Antimicrob Agents Chemother. 2000;44(6):1734–1736.
  9. Sanglard D and Coste AT. Antimicrob Agents Chemother. 2015;60(1):229–238.
  10. Kuse E-R et al. Lancet. 2007;369(9572):1519–1527.
  11. Cornely OA et al. Clin Infect Dis. 2007;44(10): 1289–1297.
  12. Lanternier F et al. J Antimicrob Chemother. 2015;70:3116–3123.
  13. Chamilos G et al. Clin Infect Dis. 2008;47(4):503–509.
  14. AmBisome® Summary of Product Characteristics (UK). Available at: https://www.medicines.org.uk/emc/product/1022/smpc#gref. Last accessed: April 2022.
  15. Wheat LG et al. Antimicrob Agents Chemother. 2001;45(8):2354–2357.
  16. Johnson PC et al. Ann Intern Med. 2002;137(2): 105–109.
  17. Wheat J et al. Medicine (Baltimore). 2018;97(13):e0245.
  18. Hamill RJ et al. Clin Infect Dis. 2010;51(2):225–232.
  19. Álvarez-Lerma F et al. J Chemother. 2009;21(3): 330–337.

Job code: IHQ-AMB-0526
Date of Preparation: April 2022