de Lima Amanda F, Fagundes Vitor L, Marques Nathália B, Borba Helena L, Domingos Eric L, Tonin Fernanda S, Pontarolo Roberto
Department of Pharmacy, Federal University of Paraná, Curitiba, BRA.
Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL) - Instituto Politécnico de Lisboa (IPL), Lisbon, PRT.
Cureus. 2024 Sep 13;16(9):e69340. doi: 10.7759/cureus.69340. eCollection 2024 Sep.
This study aimed at synthesizing the available evidence on the comparative safety and efficacy of antifungal agents for preventing or treating oral candidiasis (OC) in oncologic patients. A systematic review following international recommendations was performed (PROSPERO CRD42024507745). A comprehensive search was conducted in PubMed, Scopus, and Web of Science (Feb 2024) to retrieve randomized controlled trials evaluating the clinical effects of antifungal agents in the management of OC in this vulnerable population. Network meta-analyses were performed to evaluate the most prevalent outcomes, with findings reported as odds ratios (ORs) with 95% confidence intervals (CIs). Overall, 24 trials were included, of which 10 addressed OC treatment and 14 disease prophylaxis (n=3449 patients). Fluconazole had the most significant rates of clinical cure when compared to placebo (OR 0.09 [95% CI 0.01-0.69]), amphotericin B (0.21 [95% CI 0.07-0.65]) and itraconazole (OR 0.58 [95% CI 0.34-0.99]); ketoconazole was also superior to placebo for this outcome (OR 0.10 [95% CI 0.03, 0.36]). All antifungal agents presented significantly higher rates of prophylaxis success compared to the absence of an active agent. While these therapies were generally considered safe, only four studies provided data on adverse events, primarily related to gastrointestinal issues. In oncologic patients, azoles (fluconazole, ketoconazole) should be used as a first-line approach for OC treatment. The selection of antifungal agents for disease prophylaxis should consider, among others, patients' clinical characteristics and preferences. Economic and quality of life-related outcomes should be further addressed in future studies.
本研究旨在综合现有证据，探讨抗真菌药物在预防或治疗肿瘤患者口腔念珠菌病（OC）方面的比较安全性和疗效。按照国际建议进行了一项系统评价（PROSPERO CRD42024507745）。于2024年2月在PubMed、Scopus和科学网进行了全面检索，以获取评估抗真菌药物在该脆弱人群中治疗OC临床效果的随机对照试验。进行了网状荟萃分析以评估最常见的结局，结果以95%置信区间（CI）的比值比（OR）报告。总体而言，纳入了24项试验，其中10项涉及OC治疗，14项涉及疾病预防（n = 3449例患者）。与安慰剂（OR 0.09 [95% CI 0.01 - 0.69]）、两性霉素B（0.21 [95% CI 0.07 - 0.65]）和伊曲康唑（OR 0.58 [95% CI 0.34 - 0.99]）相比，氟康唑的临床治愈率最高；酮康唑在这一结局方面也优于安慰剂（OR 0.10 [95% CI 0.03, 0.36]）。与未使用活性剂相比，所有抗真菌药物的预防成功率均显著更高。虽然这些疗法一般被认为是安全的，但只有四项研究提供了不良事件数据，主要与胃肠道问题有关。在肿瘤患者中，唑类药物（氟康唑、酮康唑）应用作OC治疗的一线用药。疾病预防抗真菌药物的选择应考虑患者的临床特征和偏好等因素。未来研究应进一步探讨经济和生活质量相关结局。
