Cheng Jing, Han Hedong, Kang Wenwen, Cai Zijin, Zhan Ping, Lv Tangfeng
Department of Respiratory and Critical Care Medicine, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.
Front Microbiol. 2024 Dec 2;15:1504826. doi: 10.3389/fmicb.2024.1504826. eCollection 2024.
Voriconazole, isavuconazole, and amphotericin (AmB) formulations are currently recommended to treat invasive pulmonary aspergillosis (IPA). We aimed to estimate the efficacy of different antifungal drugs in the initial treatment of IPA.
We included all available randomized controlled trials (RCTs) evaluating first-line treatments for IPA by searching PubMed, Medline, EMBASE, the Cochrane Library, and the ClinicalTrials.gov database. We performed a network meta-analysis to compare the relative efficacy of different drugs in treating IPA. The primary outcomes were the overall response and all-cause mortality (ACM).
Eight studies were identified that compared different drugs including voriconazole, isavuconazole, posaconazole, anidulafungin, liposomal AmB (L-AmB) at standard, high and low doses (3-5 mg/kg/d; 10 mg/kg/d; 1 mg/kg/d), AmB deoxycholate (dAmB) and amphotericin B colloidal dispersion (ABCD). We found that second-generation triazole antifungal drugs containing voriconazole, isavuconazole, and posaconazole exhibited significantly superior overall response to dAmB and ABCD. Voriconazole was ranked as the best drug on network rank analysis. We found no difference in efficacy between triazole antifungals and L-AmB. A combination of voriconazole with anidulafungin, isavuconazole and voriconazole showed significantly better safety than dAmB.
The efficacy of second-generation triazole antifungal drugs for the first-line treatment of IPA is comparable with L-AmB and is better than both dAmB and ABCD. Isavuconazole may show better safety than voriconazole and posaconazole. Combination therapy with voriconazole and anidulafungin may serve as an alternative option for IPA patients with limited drug tolerance.
伏立康唑、艾沙康唑和两性霉素（AmB）制剂目前被推荐用于治疗侵袭性肺曲霉病（IPA）。我们旨在评估不同抗真菌药物在IPA初始治疗中的疗效。
通过检索PubMed、Medline、EMBASE、Cochrane图书馆和ClinicalTrials.gov数据库，纳入所有评估IPA一线治疗的随机对照试验（RCT）。我们进行了网络荟萃分析，以比较不同药物治疗IPA的相对疗效。主要结局为总体反应和全因死亡率（ACM）。
共纳入8项研究，比较了不同药物，包括伏立康唑、艾沙康唑、泊沙康唑、阿尼芬净、标准剂量、高剂量和低剂量（3 - 5mg/kg/d；10mg/kg/d；1mg/kg/d）的脂质体AmB（L-AmB）、去氧胆酸盐AmB（dAmB）和两性霉素B胶体分散液（ABCD）。我们发现，含伏立康唑、艾沙康唑和泊沙康唑的第二代三唑类抗真菌药物对dAmB和ABCD的总体反应显著更优。在网络排名分析中，伏立康唑被列为最佳药物。我们发现三唑类抗真菌药物与L-AmB之间疗效无差异。伏立康唑与阿尼芬净联合使用、艾沙康唑与伏立康唑联合使用的安全性显著优于dAmB。
第二代三唑类抗真菌药物用于IPA一线治疗的疗效与L-AmB相当，且优于dAmB和ABCD。艾沙康唑的安全性可能优于伏立康唑和泊沙康唑。伏立康唑与阿尼芬净联合治疗可能是药物耐受性有限的IPA患者的替代选择。
