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dc.contributor.authorBow, EJ
dc.contributor.authorVanness, DJ
dc.contributor.authorSlavin, M
dc.contributor.authorCordonnier, C
dc.contributor.authorCornely, OA
dc.contributor.authorMarks, DI
dc.contributor.authorPagliuca, A
dc.contributor.authorSolano, C
dc.contributor.authorCragin, L
dc.contributor.authorShaul, AJ
dc.contributor.authorSorensen, S
dc.contributor.authorChambers, R
dc.contributor.authorKantecki, M
dc.contributor.authorWeinstein, D
dc.contributor.authorSchlamm, H
dc.date.accessioned2020-12-21T01:13:13Z
dc.date.available2020-12-21T01:13:13Z
dc.date.issued2015-03-17
dc.identifierpii: 10.1186/s12879-015-0855-6
dc.identifier.citationBow, E. J., Vanness, D. J., Slavin, M., Cordonnier, C., Cornely, O. A., Marks, D. I., Pagliuca, A., Solano, C., Cragin, L., Shaul, A. J., Sorensen, S., Chambers, R., Kantecki, M., Weinstein, D. & Schlamm, H. (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 INFECTIOUS DISEASES, 15 (1), https://doi.org/10.1186/s12879-015-0855-6.
dc.identifier.issn1471-2334
dc.identifier.urihttp://hdl.handle.net/11343/256419
dc.description.abstractBACKGROUND: 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.
dc.languageEnglish
dc.publisherBIOMED CENTRAL LTD
dc.titleSystematic review and mixed treatment comparison meta-analysis of randomized clinical trials of primary oral antifungal prophylaxis in allogeneic hematopoietic cell transplant recipients
dc.typeJournal Article
dc.identifier.doi10.1186/s12879-015-0855-6
melbourne.affiliation.departmentMedicine and Radiology
melbourne.source.titleBMC Infectious Diseases
melbourne.source.volume15
melbourne.source.issue1
dc.rights.licenseCC BY
melbourne.elementsid1092331
melbourne.contributor.authorSlavin, Monica
dc.identifier.eissn1471-2334
melbourne.accessrightsOpen Access


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