{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:42:02Z","timestamp":1791934922273,"version":"4.3.4"},"reference-count":19,"publisher":"European Respiratory Society (ERS)","issue":"4","license":[{"start":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T00:00:00Z","timestamp":1631145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.ersjournals.com\/user-licence"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2021,8,29]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Whether a combination of glucocorticoid and antifungal triazole is superior to glucocorticoid alone in reducing exacerbations in patients with allergic bronchopulmonary aspergillosis (ABPA) remains unknown. We aimed to compare the efficacy and safety of prednisolone\u2013itraconazole combination<jats:italic>versus<\/jats:italic>prednisolone monotherapy in ABPA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We randomised subjects with treatment-na\u00efve acute-stage ABPA complicating asthma to receive either prednisolone alone (4\u2005months) or a combination of prednisolone and itraconazole (4 and 6\u2005months, respectively). The primary outcomes were exacerbation rates at 12\u2005months and glucocorticoid-dependent ABPA within 24\u2005months of initiating treatment. The key secondary outcomes were response rates, percentage decline in serum total IgE at 6\u2005weeks, time to first ABPA exacerbation and treatment-emergent adverse events (TEAEs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We randomised 191 subjects to receive either prednisolone (n=94) or prednisolone\u2013itraconazole combination (n=97). The 1-year exacerbation rate was 33% and 20.6% in the prednisolone monotherapy and prednisolone\u2013itraconazole combination arms, respectively (p=0.054). None of the participants progressed to glucocorticoid-dependent ABPA. All of the subjects experienced a composite response at 6\u2005weeks, along with a decline in serum total IgE (mean decline 47.6%<jats:italic>versus<\/jats:italic>45.5%). The mean time to first ABPA exacerbation (417\u2005days) was not different between the groups. None of the participants required modification of therapy due to TEAEs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There was a trend towards a decline in ABPA exacerbations at 1\u2005year with the prednisolone\u2013itraconazole combination<jats:italic>versus<\/jats:italic>prednisolone monotherapy. A three-arm trial comparing itraconazole and prednisolone monotherapies with their combination, preferably in a multicentric design, is required to define the best treatment strategy for acute-stage ABPA.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.01787-2021","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T16:02:32Z","timestamp":1631203352000},"page":"2101787","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":64,"title":["A randomised trial of prednisolone<i>versus<\/i>prednisolone and itraconazole in acute-stage allergic bronchopulmonary aspergillosis complicating asthma"],"prefix":"10.1183","volume":"59","author":[{"given":"Ritesh","family":"Agarwal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valliappan","family":"Muthu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6505-6019","authenticated-orcid":false,"given":"Inderpaul Singh","family":"Sehgal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahajal","family":"Dhooria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuruswamy Thurai","family":"Prasad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep","family":"Garg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh Nath","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arunaloke","family":"Chakrabarti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2021,9,9]]},"reference":[{"key":"2024102102394769000_59.4.2101787.1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3390\/jof2020017","article-title":"Allergic bronchopulmonary aspergillosis","volume":"2","author":"Tracy","year":"2016","journal-title":"J Fungi"},{"key":"2024102102394769000_59.4.2101787.2","doi-asserted-by":"crossref","first-page":"529","DOI":"10.4103\/ijmr.IJMR_1187_19","article-title":"Allergic bronchopulmonary aspergillosis","volume":"151","author":"Agarwal","year":"2020","journal-title":"Indian J Med Res"},{"key":"2024102102394769000_59.4.2101787.3","doi-asserted-by":"publisher","DOI":"10.1186\/2045-7022-4-14"},{"key":"2024102102394769000_59.4.2101787.4","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.5415\/apallergy.2018.8.e24","article-title":"Allergic bronchopulmonary mycosis \u2013 pathophysiology, histology, diagnosis, and treatment","volume":"8","author":"Asano","year":"2018","journal-title":"Asia Pac Allergy"},{"key":"2024102102394769000_59.4.2101787.5","doi-asserted-by":"publisher","DOI":"10.1378\/chest.100.3.813"},{"key":"2024102102394769000_59.4.2101787.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200003163421102"},{"key":"2024102102394769000_59.4.2101787.7","doi-asserted-by":"publisher","DOI":"10.1067\/mai.2003.1388"},{"key":"2024102102394769000_59.4.2101787.8","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1111\/myc.13124","article-title":"Role of recombinant Aspergillus fumigatus antigens in diagnosing Aspergillus sensitisation among asthmatics","volume":"63","author":"Muthu","year":"2020","journal-title":"Mycoses"},{"key":"2024102102394769000_59.4.2101787.9","doi-asserted-by":"publisher","DOI":"10.1002\/path.1700880119"},{"key":"2024102102394769000_59.4.2101787.10","doi-asserted-by":"publisher","DOI":"10.1111\/myc.12541"},{"key":"2024102102394769000_59.4.2101787.11","first-page":"260","article-title":"Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: a distinct subset of ABPA with a lesser risk of exacerbation","volume":"58","author":"Muthu","year":"2020","journal-title":"Med Mycol"},{"key":"2024102102394769000_59.4.2101787.12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw326"},{"key":"2024102102394769000_59.4.2101787.13","doi-asserted-by":"crossref","first-page":"2608","DOI":"10.1016\/j.jaip.2020.02.031","article-title":"Treating allergic bronchopulmonary aspergillosis with short-term prednisone and itraconazole in cystic fibrosis","volume":"8","author":"Gothe","year":"2020","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2024102102394769000_59.4.2101787.14","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12141"},{"key":"2024102102394769000_59.4.2101787.15","doi-asserted-by":"publisher","DOI":"10.1067\/mcp.2002.127397"},{"key":"2024102102394769000_59.4.2101787.16","doi-asserted-by":"publisher","DOI":"10.1159\/000095941"},{"key":"2024102102394769000_59.4.2101787.17","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01475-2015"},{"key":"2024102102394769000_59.4.2101787.18","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01159-2018"},{"key":"2024102102394769000_59.4.2101787.19","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.chest.2018.01.005","article-title":"A randomized trial of itraconazole vs prednisolone in acute-stage allergic bronchopulmonary aspergillosis complicating asthma","volume":"153","author":"Agarwal","year":"2018","journal-title":"Chest"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.01787-2021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T05:47:23Z","timestamp":1740376043000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.01787-2021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,9]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,28]]},"published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1183\/13993003.01787-2021"],"URL":"https:\/\/doi.org\/10.1183\/13993003.01787-2021","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,9]]}}}