Newer antifungal agents micafungin and voriconazole for fungal infection prevention during hematopoietic cell transplantation: meta-analysis / 中国医师杂志

ABSTRACT

Objective To compare the newer antifungal agents micafungin and voriconazole for prophylaxis effects on the clinical outcomes.Methods We electronically searched the database of Cochrane Central Register of Controlled Trials,Pubmed,EMbase,China Biology Medicine (CBM),China National Knowledge Infrastructure(CNKI),and relevant database articles (1996.01-2014.12).Comparative studies were carried out on proved fungal infections,mortality,and adverse effects.Meta-analysis was performed by Review Manager 5.3 software.Results We found 1 564 records and 16 studies totaling 4 234patients included in analyses.Pooled comparisons of studies found that antifungal prophylaxis with the new agents did reduce the incidence of invasive fungal infections and transplant related mortality than fluconazole or itraconazole [OR =0.41 (0.21 ～ 0.80) and OR =0.40 (0.24 ～ 0.66),respectively,P ＜ 0.01].Voriconazole had higher rates of liver dysfunction,lower gastrointestinal side effects over fluconazole,and lower rates of nephrotoxic effects than amphotericin B.Voriconazole had significant decrease in adverse events requiring drug discontinuation compared to itraconazole [OR =0.43 (0.27 ～ 0.68),P ＜ 0.01].Conclusions This analysis indicated the 2 agents appear to be well tolerated with manageable side effects and beneficial in the prophylaxis of invasive fungal infection (IFI).