Xu S-X, Shen J-L, Tang X-F, Feng B
Department of Medical Information, Navy General Hospital, Beijing, China.
Transplant Proc. 2013 Jan-Feb;45(1):407-14. doi: 10.1016/j.transproceed.2012.07.149.
The efficacy of newer antifungal agents to provide effective prophylaxis during stem cell transplantation has not yet been established. We compared the clinical outcomes using of the newer triazoles and echinocandins for antifungal prophylaxis.
We electronically searched the databases of Cochrane Central Register of Controlled Trials, Pubmed, EMBASE, and relevant articles from 1987 through 2011. We examined comparative studies for survival, proven fungal infections, mortality, and adverse effects. Our meta-analysis was performed by Review Manager 5.1.6 software with funnel plot regression analysis to assess publication bias.
Among 1443 records were 17 studies including 5122 patients for analyses. Pooled comparisons of studies showed antifungal prophylaxis with the new agents to reduce the incidence of invasive fungal infections greater than fluconazole or itraconazole. A reduction in invasive fungal infections was achieved using micafungin, voriconazole, and posaconazole for antifungal prophylaxis. Posaconazole and voriconazole prophylaxis decreased transplant mortality compared with fluconazole or itraconazole prophylaxis. Voriconazole and posaconzole showed greater rates of liver dysfunction and lower incidences gastrointestinal side effects than fluconazole. Caspofungin and voriconazole treatment incurred lower rates of nephrotoxic effects than amphotericin B. Only voriconazole displayed significantly decreased adverse events requiring drug discontinuation compared with fluconazole or itraconazole.
This analysis indicated new antifungal agents were well-tolerated with manageable side effects. They were beneficial for prophylaxis of invasive fungal infections.
新型抗真菌药物在干细胞移植期间提供有效预防的疗效尚未确定。我们比较了使用新型三唑类和棘白菌素类进行抗真菌预防的临床结果。
我们通过电子方式检索了Cochrane对照试验中央注册库、PubMed、EMBASE的数据库以及1987年至2011年的相关文章。我们检查了关于生存、确诊真菌感染、死亡率和不良反应的比较研究。我们的荟萃分析由Review Manager 5.1.6软件进行，并采用漏斗图回归分析来评估发表偏倚。
在1443条记录中有17项研究，共5122例患者纳入分析。研究汇总比较显示，与氟康唑或伊曲康唑相比，使用新型药物进行抗真菌预防可降低侵袭性真菌感染的发生率。使用米卡芬净、伏立康唑和泊沙康唑进行抗真菌预防可降低侵袭性真菌感染的发生率。与氟康唑或伊曲康唑预防相比，泊沙康唑和伏立康唑预防可降低移植死亡率。与氟康唑相比，伏立康唑和泊沙康唑的肝功能障碍发生率更高，胃肠道副作用发生率更低。与两性霉素B相比，卡泊芬净和伏立康唑治疗的肾毒性发生率更低。与氟康唑或伊曲康唑相比，只有伏立康唑显示因不良事件而停药的情况显著减少。
该分析表明新型抗真菌药物耐受性良好，副作用可控。它们有利于预防侵袭性真菌感染。
