Lipid-based amphotericin B formulations (ABCD/L-AmB) were associated with better outcomes than deoxycholate (AmB-d) in non-HIV-associated cryptococcal meningitis: A retrospective cohort study

This retrospective cohort study compared the efficacy and safety of lipid-based amphotericin B formulations (amphotericin B colloidal dispersion [ABCD] and liposomal amphotericin B [L-AmB]) versus conventional amphotericin B deoxycholate (AmB-d) for the treatment of non-human immunodeficiency virus (HIV)-associated cryptococcal meningitis (CM). Data from 199 patients were analyzed, divided into three groups based on induction therapy: AmB-d (n = 110), ABCD (n = 44), and L-AmB (n = 45). At baseline, a higher proportion of patients in the lipid-based groups presented with altered mental status. After 2 weeks, the ABCD and L-AmB groups showed significantly better clinical improvement (as measured by British Medical Research Council Stage 1) compared to the AmB-d group (63.6% and 77.8% vs. 35.5%; P < .001), and experienced substantially lower rates of renal impairment (54.5% and 53.3% vs. 79.1%; P = .001). Early fungicidal activity was similar across all groups. Multivariate analysis at 10 weeks indicated that both lipid-based formulations were associated with a lower risk of unsuccessful outcomes compared to AmB-d. Furthermore, 1-year survival analysis for clinical cure demonstrated a significantly higher cumulative incidence in the lipid-based AmB groups (Log-rank test, P = .016). In conclusion, induction regimens based on ABCD or L-AmB were associated with better outcomes than AmB-d for non-HIV-associated CM, offering better long-term outcomes and a more favorable safety profile, particularly regarding kidney toxicity.