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

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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:
CreatorsEmailORCIDORCID Put Code
Bow, Eric J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vanness, David J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Slavin, MonicaUNSPECIFIEDorcid.org/0000-0002-8443-314XUNSPECIFIED
Cordonnier, CatherineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cornely, Oliver A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Marks, David I.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pagliuca, AntonioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Solano, CarlosUNSPECIFIEDorcid.org/0000-0001-8787-1594UNSPECIFIED
Cragin, LaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shaul, Alissa J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sorensen, SonjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chambers, RichardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kantecki, MichalUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weinstein, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schlamm, HaranUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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:
KeywordsLanguage
INVASIVE FUNGAL-INFECTIONS; MYCOSES STUDY-GROUP; BONE-MARROW-TRANSPLANTATION; DOSE AMPHOTERICIN-B; EUROPEAN-ORGANIZATION; NETWORK METAANALYSIS; IMMUNOCOMPROMISED PATIENTS; FLUCONAZOLE; THERAPY; CANCERMultiple languages
Infectious DiseasesMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/40486

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