- Design
- Retrospective registry cohort with inverse probability weighting
- Population
- 3,096 people with cystic fibrosis and incident ABPA, 2006–2022
- Primary outcome
- Lung function change, exacerbations and relapse by first treatment
- Effect
- No difference for combination or antifungal monotherapy vs corticosteroids alone
This US retrospective registry study included 3,096 people with cystic fibrosis and a first diagnosis of allergic bronchopulmonary aspergillosis (ABPA) between 2006 and 2022. It compared oral corticosteroids alone, antifungals alone and the combination, using weighting to balance groups.
Corticosteroid monotherapy was associated with an improvement in the slope of FEV1 percent predicted after starting (0.24 points, 95% CI 0.09–0.38). Neither combination therapy nor antifungal monotherapy was associated with better lung function, fewer exacerbations or less relapse than corticosteroids alone.
Antifungals are widely added in ABPA, with drug interactions and side effects that matter — especially with CFTR modulators. These data suggest the routine addition may not add benefit, though only a trial can settle it.
- Oral corticosteroids remain first-line for ABPA in cystic fibrosis.
- Adding an antifungal was not associated with better outcomes in this registry.
- Check for azole interactions with CFTR modulators before adding an antifungal.
- Reserve antifungals for specific indications, such as steroid dependence or intolerance, rather than routine use.
Why it matters
Antifungals are commonly added despite little evidence, and they bring interactions with modern CF therapy.
Don't overread it
Observational data, even with weighting, cannot rule out that sicker patients received antifungals.
The statistics, in plain English
Inverse probability of treatment weighting re-balances groups to look like a trial on measured factors, but unmeasured differences can still bias the comparison.
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