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Chronic pulmonary aspergillosis (CPA) usually manifests as cough, hemoptysis, and weight loss with one or more pulmonary cavities and appears most frequently in countries with a high incidence of tuberculosis. Current guidelines recommend either itraconazole or voriconazole as first-line therapy. While voriconazole has advantages in bioavailability, lung penetration, and fungicidal activity, itraconazole is cheaper and has fewer adverse side effects. Yet direct head-to-head comparisons are lacking.
In this industry-funded, open-label trial, researchers in India randomized 116 treatment-naive adults with symptomatic CPA to oral itraconazole or voriconazole daily for 6 months. Most patients had aspergillomas in prior tuberculous pulmona…