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Patients with controlled ABPA after 4-month attack treatment (corticosteroids and itraconazole) were randomly assigned to nebulised liposomal amphotericin-B or placebo for 6\u2005months. The primary outcome was occurrence of a first severe clinical exacerbation within 24\u2005months following randomisation. Secondary outcomes included the median time to first severe clinical exacerbation, number of severe clinical exacerbations per patient, ABPA-related biological parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 174 enrolled patients with ABPA from March 2015 through July 2017, 139 were controlled after 4-month attack treatment and were randomised. The primary outcome occurred in 33 (50.8%) out of 65 patients in the nebulised liposomal amphotericin-B group and 38 (51.3%) out of 74 in the placebo group (absolute difference \u22120.6%, 95% CI \u221216.8\u2013 +15.6%; OR 0.98, 95% CI 0.50\u20131.90; p=0.95). The median (interquartile range) time to first severe clinical exacerbation was longer in the liposomal amphotericin-B group: 337 days (168\u2013476 days)<jats:italic>versus<\/jats:italic>177 days (64\u2013288 days). At the end of maintenance therapy, total immunoglobulin-E and<jats:italic>Aspergillus<\/jats:italic>precipitins were significantly decreased in the nebulised liposomal amphotericin-B group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In ABPA, maintenance therapy using nebulised liposomal amphotericin-B did not reduce the risk of severe clinical exacerbation. The presence of some positive secondary outcomes creates clinical equipoise for further research.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.02218-2021","type":"journal-article","created":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T17:10:24Z","timestamp":1636650624000},"page":"2102218","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":42,"title":["Nebulised liposomal amphotericin-B as maintenance therapy in allergic bronchopulmonary aspergillosis: a randomised, multicentre 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