Assessing the Safety and Efficacy of High-Dose Liposomal Amphotericin B: A Comprehensive Systematic Review and Meta-analysis in Microbial Pathogens

Objective: To systematically evaluate the efficacy, mortality, survival rate, and adverse reactions of high-dose liposomal amphotericin B (L-AMB) in disease treatment. Methods: : Reports of randomized controlled trials (RCTs; whether randomized, single-blind, or double-blind) of high-dose L-AMB treatment of diseases were retrieved from the PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. The primary outcome was the overall therapeutic effect, and the secondary outcomes were mortality, the ≥10-week survival rate, and adverse reactions. Meta-analysis of data was performed with RevMan5.3. The PROSPERO registration number for this review is CRD42022368973. Results: : Ten RCTs in 1,661 patients were included. High-dose L-AMB had no obvious therapeutic advantage in the anti-infection treatment. Furthermore, treatment of invasive Aspergillus infection with high-dose L-AMB led to high mortality and a low survival rate (≥10 weeks). Subgroup analysis revealed that the incidence of adverse reactions during invasive fungal infections and the incidence of renal dysfunction were higher for high-dose L-AMB than for regular-dose L-AMB. Conclusion: High-dose L-AMB had no obvious advantage for the treatment of diseases and was accompanied by a risk of increased mortality, reduced long-term survival rate, and increased adverse reactions, including renal insufficiency. Therefore, high-dose L-AMB to control infections is recommended with caution only when the preferred treatments are contraindicated.