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A network meta‐analysis of primary prophylaxis for invasive fungal infection in haematological patients
Author(s) -
Leonart L. P.,
Tonin F. S.,
Ferreira V. L.,
Penteado S. T. S.,
Wiens A.,
Motta F. A.,
Pontarolo R.
Publication year - 2017
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.12579
Subject(s) - voriconazole , jadad scale , medicine , posaconazole , meta analysis , placebo , randomized controlled trial , incidence (geometry) , systematic review , cochrane library , aspergillosis , intensive care medicine , surgery , antifungal , medline , immunology , biology , pathology , dermatology , alternative medicine , biochemistry , physics , optics
Summary What is known and objective Antifungal prophylaxis is an option to reduce the incidence of invasive fungal infection ( IFI ) in haematological patients. To date, no network meta‐analysis ( NMA ) of high‐quality evidence (double‐blind randomized controlled trials) has been performed on this subject. This systematic review and NMA aimed to evaluate the safety and efficacy of different antifungal agents used for prophylaxis of IFI in patients with haematological disorders. Methods A systematic review was performed according to PRISMA and Cochrane recommendations. The search for articles was conducted on PubMed, Scopus and the Web of Science. We searched for double‐blind randomized clinical trials comparing antifungal agents for IFI prophylaxis head‐to‐head vs placebo in patients with any blood cancer. Network meta‐analyses were conducted using Addis version 1.16.6. Evaluation of the quality of included RCT s was also performed. Results Twenty‐five trials were included in the qualitative and quantitative analyses. Posaconazole stood out as the best IFI prophylaxis option and for avoiding IFI ‐related mortality. For the incidence of candidiasis outcome, the azoles were superior to placebo. Voriconazole and posaconazole were, respectively, the first and second best options. For the incidence of aspergillosis outcome, the probability rank suggested that voriconazole followed by liposomal amphotericin B is, possibly, the best choice. The quality of studies was considered good, with a mean Jadad score of 4.0. What is new and conclusion The results of our work support prophylaxis with antifungal agents as reducing the risk of IFI in haematological patients. Overall, the second‐generation azoles were found to be the best option for preventing IFI in this population.