No added benefit from antifungals over steroids for ABPA in CF

A retrospective cohort study of 3,096 people with cystic fibrosis diagnosed with allergic bronchopulmonary aspergillosis (ABPA) between 2006 and 2022 examined real-world treatment patterns and outcomes with oral corticosteroids (OCS), antifungals, or combination therapy. The study reported that OCS monotherapy was associated with improved lung function (FEV1% predicted slope) after treatment initiation, while combination therapy or antifungal monotherapy showed no significant differences compared to OCS alone in lung function decline, time to pulmonary exacerbation, or time to clinical relapse. The study also found that older age, CFTR modulator use, and CF liver disease were associated with later antifungal initiation, while prior exacerbations, larger care center size, and OCS use were associated with earlier initiation.

Most relevant for: People with cystic fibrosis who develop allergic bronchopulmonary aspergillosis and require treatment decisions regarding corticosteroids versus antifungal therapy.

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