棘白菌素单药治疗和联合治疗免疫功能低下的系统性念珠菌病患者的疗效和安全性：一项系统评价和荟萃分析。

Efficacy and safety of echinocandin monotherapy and combination therapy for immunocompromised patients with systemic candidiasis: A systematic review and meta-analysis.

作者信息

Tang Brenda Hui En, Bay Jia Wei, Yeong Foong May, Samuel Miny

机构信息

Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Republic of Singapore.

出版信息

J Mycol Med. 2023 May;33(2):101362. doi: 10.1016/j.mycmed.2023.101362. Epub 2023 Feb 16.

DOI:10.1016/j.mycmed.2023.101362

PMID:36867970

Abstract

BACKGROUND

Systemic candidiasis is caused by Candida invading the bloodstream. The efficacy and safety of echinocandins in monotherapy and combination therapy regimes have not been adequately compared in immunocompromised patients with Candidiasis, and thus this systematic review aims to do so.

METHODS

A protocol was prepared a priori. PubMed, Embase and Cochrane Library databases were searched systematically (from inception of each database to September 2022) to identify randomized controlled trials. Two reviewers performed screening, quality assessment of trials, and extracted data independently. Pairwise meta-analysis was performed using random-effects model to compare echinocandin monotherapy versus other antifungals. The primary outcomes of interest were treatment success and treatment-related adverse events.

RESULTS

547 records (PubMed=310, EMBASE=210 and Cochrane Library=27) were reviewed. Following our screening criteria, six trials involving 177 patients were included. Risk of bias of four included studies had some concerns due to lack of a pre-specified analysis plan. Meta-analysis shows that echinocandin monotherapy does not have significantly higher rates of "treatment success" compared to other classes of antifungals (RR 1.12, 95%CI 0.80-1.56). However, echinocandins appeared to be significantly safer than other forms of antifungal therapy (RR 0.79, 95%CI 0.73-0.86).

CONCLUSION

Our findings have shown that echinocandin monotherapy (micafungin, caspofungin) given intravenously are just as effective as other antifungals (amphotericin B, itraconazole) in the treatment of systemic candidiasis in immunocompromised patients. There appears to be similar benefits when using echinocandins compared to amphotericin B which has also been used as a broad-spectrum antifungal, while avoiding the severe adverse effects that amphotericin B causes, such as nephrotoxicity.

摘要

背景

系统性念珠菌病是由念珠菌侵入血流引起的。在免疫功能低下的念珠菌病患者中，棘白菌素在单药治疗和联合治疗方案中的疗效和安全性尚未得到充分比较，因此本系统评价旨在进行此类比较。

方法

预先制定了方案。系统检索了PubMed、Embase和Cochrane图书馆数据库（从每个数据库建立至2022年9月）以识别随机对照试验。两名评价员独立进行筛选、试验质量评估并提取数据。采用随机效应模型进行成对荟萃分析，以比较棘白菌素单药治疗与其他抗真菌药物。主要关注的结局是治疗成功和治疗相关不良事件。

结果

共检索了547条记录（PubMed=310，EMBASE=210，Cochrane图书馆=27）。根据筛选标准，纳入了6项涉及177例患者的试验。由于缺乏预先指定的分析计划，4项纳入研究的偏倚风险存在一些问题。荟萃分析表明，与其他类抗真菌药物相比，棘白菌素单药治疗的“治疗成功”率没有显著更高（风险比1.12，95%置信区间0.80-1.56）。然而，棘白菌素似乎比其他形式的抗真菌治疗显著更安全（风险比0.79，95%置信区间0.73-0.86）。