Yang Yan-Li, Xiang Zi-Jian, Yang Jing-Hua, Wang Wen-Jie, Xu Zhi-Chun, Xiang Ruo-Lan
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Beijing Zhiyun Data Technology Co., Ltd., Beijing, China.
Front Pharmacol. 2021 Oct 29;12:697330. doi: 10.3389/fphar.2021.697330. eCollection 2021.
Invasive fungal infections (IFI) is an important contributing factor in morbidity and mortality of immunocompromised and critically ill patients. Although the therapeutic effects of these drugs on IFI have been well documented, the long-term use of antifungal agents has raised concerns about drug tolerability and treatment-related toxicity risks. We searched articles published before June 30, 2020 in four electronic databases: Web of Science, Cochrane Library, embase and PubMed. 66 trials were determined to meet our inclusion criteria, providing data on 18,230 participants. We sorted out 23 AEs by system organ classes and six laboratory AEs, 13 of these were used to construct 13 network meta-analyses. Compared with LAmB, anidulafungin, caspofungin, micafungin, fluconazole, and posaconazole had a significantly low incidence of discontinuation of therapy due to AEs (OR = 0.24 (0.09,0.65), 0.24 (0.13,0.43), 0.32 (0.19,0.52), 0.38 (0.23,0.62) and 0.35 (0.17,0.69), respectively). We found that echinocandins are the most tolerated antifungal agents with high safety. The AEs of triazole drugs are mainly concentrated on the increase in liver enzymes, nervous system disorders, especially visual disorders, gastrointestinal disorders, and cardiac diseases. LAmB is the least tolerated and has the most abundant AEs.
侵袭性真菌感染（IFI）是免疫功能低下和危重症患者发病和死亡的重要因素。尽管这些药物对IFI的治疗效果已有充分记录，但抗真菌药物的长期使用引发了对药物耐受性和治疗相关毒性风险的担忧。我们检索了截至2020年6月30日在四个电子数据库（Web of Science、Cochrane图书馆、Embase和PubMed）上发表的文章。确定有66项试验符合我们的纳入标准，提供了18230名参与者的数据。我们按系统器官类别梳理出23种不良事件（AE）和6种实验室AE，其中13种用于构建13项网络荟萃分析。与两性霉素B相比，阿尼芬净、卡泊芬净、米卡芬净、氟康唑和泊沙康唑因AE导致治疗中断的发生率显著较低（比值比分别为0.24（0.09，0.65）、0.24（0.13，0.43）、0.32（0.19，0.52）、0.38（0.23，0.62）和0.35（0.17，0.69））。我们发现棘白菌素是耐受性最高且安全性高的抗真菌药物。三唑类药物的AE主要集中在肝酶升高、神经系统紊乱，尤其是视觉障碍、胃肠道紊乱和心脏疾病。两性霉素B耐受性最差且AE最多。
