A Randomized Trial Comparing the Role of Prednisolone, Itraconazole, or Their Combination in Patients with Acute Stage of Allergic Bronchopulmonary Aspergillosis
Status: Recruiting
Location: See location...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 3
SUMMARY
The investigators hypothesize that a combination of prednisolone and itraconazole would significantly reduce the exacerbation rate at one-year of patients with acute allergic bronchopulmonary aspergillosis (ABPA) compared to itraconazole or prednisolone monotherapy. In this study, 300 subjects aged ≥18 years with acute ABPA will be randomized to treatment with either prednisolone, itraconazole, or prednisolone plus itraconazole, all for four months each. After collecting baseline demographic, immunologic, and imaging data, the investigators will follow the patients every 2 months for the first two visits and then every four months for three visits. The primary outcome will be the proportion of subjects experiencing exacerbation (asthma or ABPA) 12 months after treatment completion.
Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:
⁃ Consecutive subjects of acute stage allergic bronchopulmonary aspergillosis (ABPA) complicating asthma per the revised ISHAM-ABPA working group criteria
• newly diagnosed subjects with uncontrolled asthma or symptoms or radiology suggesting active lesions attributable to ABPA and meeting the diagnostic criteria of ABPA
• those previously meeting the diagnostic criteria for ABPA and presenting with sustained (≥2 weeks) clinical or radiological worsening; and increase in serum total IgE by ≥50% of the last recorded IgE value during clinical stability.
Locations
Other Locations
India
Chest Clinic, Dept. of Pulmonary Medicine
RECRUITING
Chandigarh
Time Frame
Start Date:2023-12-01
Estimated Completion Date:2026-06
Participants
Target number of participants:300
Treatments
Active_comparator: Prednisolone
Oral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper 5 mg every 4 weeks and discontinue by 4 months. After breakfast, oral prednisolone will be administered as a morning dose (8-10 am).
Active_comparator: Itraconazole
Oral SUBA-itraconazole 65 mg 2 capsules BD for 4 months. Oral itraconazole will be given twice daily (9 am and 9 pm) spaced one hour with meals. We will perform therapeutic drug monitoring for itraconazole at two weeks and two months. We will increase the itraconazole dose to a maximum of 390 mg/day (six 65 mg capsules) in those with trough itraconazole levels \<0.5 µg/mL.
Experimental: Prednisolone plus itraconazole
Oral prednisolone 0.5 mg/kg/day for 4 weeks; 0.25 mg/kg/day for 4 weeks; 0.125 mg/kg/day for 4 weeks. Then taper 5 mg every 4 weeks and discontinue by 4 months. After breakfast, oral prednisolone will be administered as a morning dose (8-10 am); and, Oral SUBA-itraconazole 65 mg 2 capsules BD for 4 months. Oral itraconazole will be given twice daily (9 am and 9 pm) spaced one hour with meals. We will perform therapeutic drug monitoring for itraconazole at two weeks and two months. We will increase the itraconazole dose to a maximum of 390 mg/day (six 65 mg capsules) in those with trough itraconazole levels \<0.5 µg/mL.