Abstract
INTRODUCTION: Allergic bronchopulmonary aspergillosis (ABPA) affects millions worldwide, yet current treatment approaches remain suboptimal due to a one-size-fits-all model that fails to account for the significant heterogeneity across affected populations. While corticosteroids and itraconazole are commonly prescribed, there are associated risks and uncertainties regarding efficacy. Additionally, the efficacy of alternatives such as newer and higher activity triazole antifungals, or the place of "biologic" therapies like anti-IL5 antagonists, has not been thoroughly investigated. OBJECTIVES: This review will assess treatment outcomes in patients with ABPA (Population) receiving antifungal or biologic therapies (Intervention) compared with corticosteroids, placebo, or alternative active treatments (Comparator), evaluating lung function (FEV₁), serological markers, exacerbation frequency, patient-reported outcomes, steroid-sparing effects, and adverse events (Outcomes) through a systematic review and network meta-analysis of published peer-reviewed studies. INCLUSION CRITERIA: All articles using the Population, Exposure/Intervention, Comparator, Outcomes, Duration, and Results (PECODR) framework related to human patients published in English from inception to the date of undertaking the study (present) will be included. MATERIALS AND METHODS: The following literature databases will be searched: MEDLINE, EMBASE, Cochrane Library Trials database, PubMed Central, Web of Science, and Scopus from inception to the present in collaboration with an experienced librarian. The primary researcher will screen the titles and abstracts; deduplication will be performed using Covidence®, and inclusion will be validated by a second checker. Quantitative analyses will be performed to summarise the results as means, frequency tables, and odds ratios of outcomes. Where there is sufficient data, a network meta-analysis will be conducted. The systematic review and network meta-analysis will be undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Network Meta-analysis (PRISMA-NMA) framework. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024443073.