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. 2019 May 15:12:1311-1324.
doi: 10.2147/IDR.S203579. eCollection 2019.

Comparative effectiveness of antifungal agents in patients with hematopoietic stem cell transplantation: a systematic review and network meta-analysis

Hui-Chen Su  1 , Yi-Ming Hua  1 , I Jung Feng  2 , Hung-Chang Wu  3
Affiliations

Comparative effectiveness of antifungal agents in patients with hematopoietic stem cell transplantation: a systematic review and network meta-analysis

Hui-Chen Su et al. Infect Drug Resist. .

Abstract

Purpose: The aim of this study was to use a network meta-analysis to evaluate the relative efficacy of various agents at preventing invasive fungal infections (IFIs). In this way, suitable prophylactic regimens may be selected for patients with hematopoietic stem cell transplantation (HSCT). Methods: We conducted a systematic review of randomized controlled trials comparing the prophylactic effects of two antifungal agents or an antifungal agent and a placebo administered to patients with HSCT. Relevant studies were found in the PubMed and Cochrane databases. Unpublished studies were collected from the ClinicalTrials.gov registry. Results: Sixteen two-arm studies were identified. Compared with placebo, all six antifungal agents (amphotericin B, fluconazole, itraconazole, micafungin, posaconazole, and voriconazole) presented with greater efficacy at controlling proven IFIs. OR ranged from 0.08 to 0.29. Voriconazole (surface under the cumulative ranking curve [SUCRA]=71.6%), posaconazole (SUCRA=68.9%), and itraconazole (SUCRA=64.7%) were the three top-ranking drugs for preventing proven IFIs. Itraconazole ranked highest (SUCRA=83.1%) and had the greatest efficacy at preventing invasive candidiasis. Posaconazole and micafungin were the two top-ranking drugs (SUCRA=81.3% and 78.4%, respectively) at preventing invasive aspergillosis. Micafungin and voriconazole were the drugs of choice because they lowered mortality more than the other agents (SUCRA=74.6% and 61.1%, respectively). Conclusion: This study is the first network meta-analysis to explore the prophylactic effects of antifungal agents in patients with HSCT. Voriconazole was the best choice for the prevention of proven IFIs in HSCT patients.

Keywords: antifungal agents; hematopoietic stem cell transplantation; network meta-analysis.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA process flow of study selection.
Figure 2
Figure 2
Network of antifungal agent comparisons included in the present study. Nodes represent seven investigated treatments. Node size is weighted according to the number of corresponding studies. Width of lines connecting nodes is weighted according to the number of trials comparing connected treatments (displayed next to the lines).
Figure 3
Figure 3
Summarized OR and corresponding 95% CI for multiple treatment comparisons of proven IFI.
Figure 4
Figure 4
Summarized OR and corresponding 95% CI for multiple treatment comparisons of IC infection.
Figure 5
Figure 5
Summarized OR and corresponding 95% CI for multiple treatment comparisons of IA infection.
Figure 6
Figure 6
Summarized OR and corresponding 95% CI for multiple treatment comparisons of all-cause mortality.
Figure 7
Figure 7
Scatterplot of cumulative probabilities of proven IF and mortality.
See this image and copyright information in PMC

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