Reply to: Nebulised liposomal amphotericin-B: a promising strategy for preventing ABPA relapse

Regarding their first comment on the study population, we acknowledge that a maintenance treatment might be more warranted and even more effective in patients with previous recurrent exacerbations than in patients without previous exacerbation. In our study, this hypothesis was supported by our analysis, which was restricted to patients with previous exacerbations ( i.e. in the past years). During the 24-month follow-up period, we found that in patients with at least one previous severe exacerbation before inclusion, the proportion with at least two or more severe exacerbations was 27% in the active treatment group as compared to 53% in the placebo group (p=0.03) [1]. However, in the setting of our randomised trial, we decided to include a well-defined population and to explore without “a priori” the impact of a maintenance treatment following a homogeneous attack treatment. In fact, the presence or absence of previous exacerbations might not be the only factor influencing the effect of maintenance therapy. For example, according to the computed tomography (CT) scan phenotype at inclusion [2], it could be interesting to evaluate the benefit of a maintenance strategy and its influence on future relapse or complete remission. Another interesting issue could be the impact of predictive factors, such as high-attenuation mucus impactions, on future relapses or complete remission. Is nebulised liposomal amphotericin-B a promising strategy for preventing allergic bronchopulmonary aspergillosis relapse?