唑类、多烯类和棘白菌素类抗真菌药物预防血液恶性肿瘤患者侵袭性真菌感染的网状 Meta 分析。

Network meta-analysis of triazole, polyene, and echinocandin antifungal agents in invasive fungal infection prophylaxis in patients with hematological malignancies.

机构信息

Department of Hematology, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China.

Emergency Department, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China.

出版信息

BMC Cancer. 2021 Apr 14;21(1):404. doi: 10.1186/s12885-021-07973-8.

BACKGROUND AND AIM

Triazole, polyene, and echinocandin antifungal agents are extensively used to treat invasive fungal infections (IFIs); however, the optimal prophylaxis option is not clear. This study aimed to determine the optimal agent against IFIs for patients with hematological malignancies.

METHODS

Randomized controlled trials (RCTs) comparing the effectiveness of triazole, polyene, and echinocandin antifungal agents with each other or placebo for IFIs in patients with hematological malignancies were searched. This Bayesian network meta-analysis was performed for all agents.

RESULTS

The network meta-analyses showed that all triazoles, amphotericin B, and caspofungin, but not micafungin, reduced IFIs. Posaconazole was superior to fluconazole [odds ratio (OR), 0.30; 95% credible interval (CrI), 0.12-0.60], itraconazole (OR, 0.40; 95% CrI, 0.15-0.85), and amphotericin B (OR, 4.97; 95% CrI, 1.73-11.35). It also reduced all-cause mortality compared with fluconazole (OR, 0.35; 95% CrI, 0.08-0.96) and itraconazole (OR, 0.33; 95% CrI, 0.07-0.94), and reduced the risk of adverse events compared with fluconazole (OR, 0.02; 95% CrI, 0.00-0.03), itraconazole (OR, 0.01; 95% CrI, 0.00-0.02), posaconazole (OR, 0.02; 95% CrI, 0.00-0.03), voriconazole (OR, 0.005; 95% CrI, 0.00 to 0.01), amphotericin B (OR, 0.004; 95% CrI, 0.00-0.01), and caspofungin (OR, 0.05; 95% CrI, 0.00-0.42) despite no significant difference in the need for empirical treatment and the proportion of successful treatment.

CONCLUSIONS

Posaconazole might be an optimal prophylaxis agent because it reduced IFIs, all-cause mortality, and adverse events, despite no difference in the need for empirical treatment and the proportion of successful treatment.

背景与目的

三唑类、多烯类和棘白菌素类抗真菌药物广泛用于治疗侵袭性真菌感染（IFI）；然而，最佳的预防选择尚不清楚。本研究旨在确定血液病患者IFI 的最佳预防药物。

方法

检索了比较三唑类、多烯类和棘白菌素类抗真菌药物相互之间以及与安慰剂在血液病患者 IFI 中的有效性的随机对照试验（RCT）。对所有药物进行了贝叶斯网络荟萃分析。

结果

网络荟萃分析显示，所有三唑类药物、两性霉素 B 和卡泊芬净可降低 IFI，但米卡芬净不行。泊沙康唑优于氟康唑[比值比（OR），0.30；95%可信区间（CrI），0.12-0.60]、伊曲康唑（OR，0.40；95% CrI，0.15-0.85）和两性霉素 B（OR，4.97；95% CrI，1.73-11.35）。与氟康唑（OR，0.35；95% CrI，0.08-0.96）和伊曲康唑（OR，0.33；95% CrI，0.07-0.94）相比，它还降低了全因死亡率，与氟康唑（OR，0.02；95% CrI，0.00-0.03）、伊曲康唑（OR，0.01；95% CrI，0.00-0.02）、泊沙康唑（OR，0.02；95% CrI，0.00-0.03）、伏立康唑（OR，0.005；95% CrI，0.00-0.01）、两性霉素 B（OR，0.004；95% CrI，0.00-0.01）和卡泊芬净（OR，0.05；95% CrI，0.00-0.42）相比，不良事件风险降低，但经验性治疗需求和治疗成功率无显著差异。