TY  - JOUR
AU  - Bow, EJ
AU  - Vanness, DJ
AU  - Slavin, M
AU  - Cordonnier, C
AU  - Cornely, OA
AU  - Marks, DI
AU  - Pagliuca, A
AU  - Solano, C
AU  - Cragin, L
AU  - Shaul, AJ
AU  - Sorensen, S
AU  - Chambers, R
AU  - Kantecki, M
AU  - Weinstein, D
AU  - Schlamm, H
Y2  - 2020/12/21
Y1  - 2015/03/17
SN  - 1471-2334
UR  - http://hdl.handle.net/11343/256419
AB  - 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.
LA  - English
PB  - BIOMED CENTRAL LTD
T1  - Systematic review and mixed treatment comparison meta-analysis of randomized clinical trials of primary oral antifungal prophylaxis in allogeneic hematopoietic cell transplant recipients
DO  - 10.1186/s12879-015-0855-6
IS  - BMC Infectious Diseases
VL  - 15
IS  - 1
L1  - /bitstream/handle/11343/256419/PMC4374298.pdf?sequence=1&isAllowed=y
ER  -