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SIR—Winston and Schiller [1] report the results of the analysis of their institutions's data from a multicenter, randomized study that compared amphotericin B lipid complex (ABLC; The Liposome Company) with conventional amphotericin B (CAB; Apothecon) as empiric therapy for febrile neutropenic patients. They found a similar incidence of nephrotoxicity (defined as a doubling of the baseline serum creatinine concentration) and infusion-related reactions (fever and chills) in both treatment arms, which was surprising. This prompted us to undertake a detailed examination of the available data on nephrotoxicity associated with these agents.

There is little comparative data available on nephrotoxicity associated with ABLC treatment, and, therefore, it is unfortunate that Winston and Schiller's study was prematurely discontinued by the sponsor (The Liposome Company), despite objections from the investigators. The data that we did find included the results of a comparative trial of ABLC and CAB as treatment for cryptococcal meningitis in patients with AIDS [2]. The authors of this study reported that, in the 2 treatment arms (patients who received ABLC at a dosage of 5 mg/kg/day those who received CAB at a dosage of 0.7 mg/kg/day), the mean increase in serum creatinine levels from baseline through week 1 was identical.

Issue Section:
Correspondences
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