Department of Pharmacy, Shenzhen Luohu People's Hospital, Shenzhen, China.
Department of Orthopedic Surgery, Shenzhen Luohu People's Hospital, Shenzhen, China.
Mycoses. 2022 Oct;65(10):906-917. doi: 10.1111/myc.13508. Epub 2022 Aug 4.
At present, there is still a lack of effective invasive fungal prophylaxis therapy in liver transplant recipients (LTRs). This study aimed to analysis the latest evidence on efficacy of current prophylactic anti-fungal therapy, and systematically compare between anti-fungal agents and placebo by a fixed-effects meta-analysis in all randomised controlled trials. A network meta-analysis was performed for invasive fungal infection (IFI) among different agents in 14 randomised controlled trials, in which 10 anti-fungal approaches were identified. Overall, anti-fungal prophylaxis reduced the rate of IFI (RR 0.30, 95% CI 0.18-0.52) and proven IFI (RR 0.27, 95% CI 0.14-0.53) when compared to placebo. In the network meta-analysis, an equivalent reduction in the rate of IFI was observed in fluconazole (OR 4.70, 95% CI 1.22-18.10), itraconazole (OR 5.82, 95% CI 1.10-30.71) and Liposomal amphotericin B (LAmB, OR 5.74, 95% CI 1.29-25.58) groups when compared with placebo. Anidulafungin might be the most effective agents in IFI prevention; however, this superiority did not meet statistically significance. Our study indicated that fluconazole, echinocandins and LAmB are equivalent in efficacy. Of which, fluconazole is recommended for the prevention of IFI in LTRs due to its efficacy, economics and compliance.
目前，肝移植受者（LTR）仍缺乏有效的侵袭性真菌预防治疗。本研究旨在通过固定效应荟萃分析，对所有随机对照试验中当前预防性抗真菌治疗的最新疗效证据进行分析，并对不同抗真菌药物与安慰剂进行系统比较。对 14 项随机对照试验中不同药物的侵袭性真菌感染（IFI）进行网络荟萃分析，确定了 10 种抗真菌方法。总体而言，与安慰剂相比，抗真菌预防可降低 IFI 发生率（RR 0.30，95%CI 0.18-0.52）和确诊 IFI 发生率（RR 0.27，95%CI 0.14-0.53）。在网络荟萃分析中，氟康唑（OR 4.70，95%CI 1.22-18.10）、伊曲康唑（OR 5.82，95%CI 1.10-30.71）和两性霉素 B 脂质体（LAmB，OR 5.74，95%CI 1.29-25.58）与安慰剂相比，IF I 的发生率也有同等降低。阿尼达氟可能是预防 IF I 最有效的药物；然而，这一优势没有统计学意义。我们的研究表明，氟康唑、棘白菌素类和 LAmB 在疗效上是等效的。其中，氟康唑因其疗效、经济性和依从性而被推荐用于 LTR 侵袭性真菌感染的预防。
