New Antifungal Therapy for Fungal Meningitis

A team of University of Minnesota Medical School researchers successfully tested a new antifungal therapy to treat fungal meningitis. 

The trial results were published in the peer-reviewed journal Clinical Infectious Diseases.

The research team tested a new oral formulation of the antifungal medication amphotericin among people who had HIV and cryptococcal meningitis — a common fungal infection around the brain. 

Cryptococcal meningitis is the most common cause of central nervous system infection in people living with HIV worldwide. Conventional amphotericin B can only be administered directly into veins and is highly toxic. 

The new lipid nanocrystal formulation — which was tested in the EnACT trial — can be taken orally and is non-toxic.

In this randomized trial, 141 HIV-positive people with cryptococcal meningitis received the oral amphotericin combined with oral flucytosine. This combination was found to be promising for cryptococcal meningitis in regard to antifungal activity, similar survival and less toxicity in comparison to intravenous amphotericin B. Statistically fewer lab abnormalities occurred with the six weeks of LNC-enabled oral amphotericin B compared to one week of intravenous amphotericin B. In the group given two IV loading doses then the experimental oral amphotericin formulation, 90% of participants survived >4 months compared to 85% who received one week of standard intravenous amphotericin.

“With the rising incidence of life-threatening fungal infections, our currently available conventional methods are limited by rising rates of drug resistance and toxicities,” said Mahsa Abassi, DO, assistant professor at the U of M Medical School and co-investigator on the trial. “The development of new antifungal regimens that are orally available, less toxic, and can treat highly resistant fungal infections is crucial.”

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Sources:

David R Boulware, Mucunguzi Atukunda, Enock Kagimu, Abdu K Musubire, Andrew Akampurira, Lillian Tugume, Kenneth Ssebambulidde, John Kasibante, Laura Nsangi, Timothy Mugabi, Jane Gakuru, Sarah Kimuda, Derrick Kasozi, Suzan Namombwe, Isaac Turyasingura, Morris K Rutakingirwa, Edward Mpoza, Enos Kigozi, Conrad Muzoora, Jayne Ellis, Caleb P Skipper, Theresa Matkovits, Peter R Williamson, Darlisha A Williams, Ann Fieberg, Kathy H Hullsiek, Mahsa Abassi, Biyue Dai, David B Meya. Oral Lipid Nanocrystal Amphotericin B for Cryptococcal Meningitis: A Randomized Clinical Trial. Clinical Infectious Diseases, 2023 DOI: 10.1093/cid/ciad440

University of Minnesota Medical School. (2023, August 22). New antifungal therapy for fungal meningitis. ScienceDaily. Retrieved August 24, 2023 from www.sciencedaily.com/releases/2023/08/230822111628.htm 

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