Universität zu Köln

Bow, Eric J., Vanness, David J., Slavin, Monica ORCID: 0000-0002-8443-314X, Cordonnier, Catherine, Cornely, Oliver A., Marks, David I., Pagliuca, Antonio, Solano, Carlos ORCID: 0000-0001-8787-1594, Cragin, Lael, Shaul, Alissa J., Sorensen, Sonja, Chambers, Richard, Kantecki, Michal, Weinstein, David and Schlamm, Haran (2015). Systematic review and mixed treatment comparison meta-analysis of randomized clinical trials of primary oral antifungal prophylaxis in allogeneic hematopoietic cell transplant recipients. BMC Infect. Dis., 15. LONDON: BIOMED CENTRAL LTD. ISSN 1471-2334

Full text not available from this repository.

Abstract

Background: Antifungal prophylaxis is a promising strategy for reducing invasive fungal infections (IFIs) in allogeneic hematopoietic cell transplant (alloHCT) recipients, but the optimum prophylactic agent is unknown. We used mixed treatment comparison (MTC) meta-analysis to compare clinical trials examining the use of oral antifungals for prophylaxis in alloHCT recipients, with the goal of informing medical decision-making. Methods: Randomized controlled trials (RCTs) of fluconazole, itraconazole, posaconazole, and voriconazole for primary antifungal prophylaxis were identified through a systematic literature review. Outcomes of interest (incidence of IFI/invasive aspergillosis/invasive candidiasis, all-cause mortality, and use of other antifungals) were extracted from eligible RCTs and incorporated into a Bayesian hierarchical random-effects MTC. Results: Five eligible RCTs, randomizing 2147 patients in total, were included. Relative to fluconazole, prophylaxis with itraconazole (odds ratio [OR]: 0.52; interquartile range [IQR]: 0.35-0.76), posaconazole (OR: 0.56; IQR: 0.32-0.99), and voriconazole (OR: 0.46; IQR: 0.28-0.73) reduced incidence of overall proven/probable IFI. Posaconazole (OR: 0.31; IQR: 0.17-0.58) and voriconazole (OR: 0.33; IQR: 0.17-0.58) prophylaxis reduced proven/ probable invasive aspergillosis more than itraconazole (OR: 0.68; IQR: 0.42-1.12). All-cause mortality was similar across all mould-active agents. Conclusion: As expected, mould-active azoles prevented IFIs, particularly invasive aspergillosis, more effectively than fluconazole in alloHCT recipients. The paucity of comparative efficacy data suggests that other factors such as long-term tolerability, availability of intravenous formulations, local IFI epidemiology, and drug costs may need to form the basis for selection among the mould-active azoles.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bow, Eric J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vanness, David J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Slavin, Monica UNSPECIFIED orcid.org/0000-0002-8443-314X UNSPECIFIED Cordonnier, Catherine UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, Oliver A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Marks, David I. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pagliuca, Antonio UNSPECIFIED UNSPECIFIED UNSPECIFIED Solano, Carlos UNSPECIFIED orcid.org/0000-0001-8787-1594 UNSPECIFIED Cragin, Lael UNSPECIFIED UNSPECIFIED UNSPECIFIED Shaul, Alissa J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sorensen, Sonja UNSPECIFIED UNSPECIFIED UNSPECIFIED Chambers, Richard UNSPECIFIED UNSPECIFIED UNSPECIFIED Kantecki, Michal UNSPECIFIED UNSPECIFIED UNSPECIFIED Weinstein, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlamm, Haran UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-404868
DOI:	10.1186/s12879-015-0855-6
Journal or Publication Title:	BMC Infect. Dis.
Volume:	15
Date:	2015
Publisher:	BIOMED CENTRAL LTD
Place of Publication:	LONDON
ISSN:	1471-2334
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INVASIVE FUNGAL-INFECTIONS; MYCOSES STUDY-GROUP; BONE-MARROW-TRANSPLANTATION; DOSE AMPHOTERICIN-B; EUROPEAN-ORGANIZATION; NETWORK METAANALYSIS; IMMUNOCOMPROMISED PATIENTS; FLUCONAZOLE; THERAPY; CANCER Multiple languages Infectious Diseases Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/40486