The baseline characteristics of the patients were similar in the two groups (Table 1). The number of episodes of moderate-massive haemoptysis during the study period did not

differ significantly between the groups (four in each group). The total number of radiological interventions (two bronchial artery embolisation procedures in each group) and the number of surgical procedures (three in itraconazole group and four in the control group) were also similar in the two groups during the trial. The number of patients showing overall response was higher in the itraconazole group (76.5%) compared with the control group (35.7%), and was statistically significant (P = 0.02). The Everolimus numbers of patients demonstrating a clinical response and radiological response (Fig. 2) were also significantly higher EPZ015666 in the itraconazole group (Table 2). The mean

longest diameter of pulmonary lesions in the itraconazole and control groups, respectively, was 32.4 (13.9) and 28.2 (11.7) mm, and 26.3 (9.1) and 32.4 (9.7) mm at baseline and 6 months respectively. Adverse events were noted in 8 (47.1%) patients in the itraconazole group, however, none was serious and none led to any discontinuation of the study drug. Transient abnormality of liver function was noted in two patients in the itraconazole group. In both the cases, the liver enzymes were elevated between 1.5 and 2 times the upper limit of normal. The liver function was found to be deranged at the second and third month of therapy, respectively, in the two patients. The liver functions normalised from on follow-up in these two patients despite continuation of itraconazole therapy. Gastrointestinal disturbances were documented in six patients in the itraconazole group. All the patients were followed up for a median (IQR) of 11 (7–16) months after completion of the trial. On follow-up, 9/17 (5 of 13 with overall response) and 10/14 (1 of 5 with overall response) patients worsened

in the itraconazole and control group respectively. There was radiological and clinical worsening in six and clinical worsening alone in four patients in the control group, whereas there was radiological and clinical worsening in seven and clinical worsening alone in two patients in the itraconazole group. During the follow-up four patients died, two in each group. Two patients died from uncontrolled massive haemoptysis, one patient died from postoperative sepsis whereas one patient died due to acute coronary syndrome. Our initial search retrieved 372 citations, of which 19 studies have evaluated the role of antifungal agents in CPA (Table 3).[2, 10-13, 17-30] The studies have utilised oral (itraconazole, voriconazole, posaconazole) and intravenous (amphotericin B, itraconazole, voriconazole, micafungin) antifungal agents in patients with CPA. The overall response ranges from 14% to 93% with the response lower in patients with CCPA and highest in those with CNPA (Table 4).