Meta-analysis of the Efficacy and Safety of Echinocandins as Antifungal Agents in the Prevention of Invasive Candidiasis / 中国药房

ABSTRACT

ABSTRACT OBJECTIVE：To systematically evaluate the efficacy and safety of echinococcins in the prevention of invasive candidiasis，and to provide evidence-based reference for clinical treatment. METHODS：Retrieved from PubMed，Embase， Medline，Cochrane library，CJFD，VIP and Wanfang database，randomized controlled trials（RCTs）about the effectiveness and safety of echinococcins （trial group） versus conventional fungal drugs （amphotericin B and triazole antifungal agents，control group）in the prevention of invasive candidiasis were collected during database establishment to Jul. 2019. After data extraction of clinical studies met inclusion criteria and quality evaluation with Cochrane system evaluator manual 5.0.2，Meta-analysis was performed for breakthrough invasive fungal infection rate，fungal infection mortality rate，all-cause mortality rate and the incidence of drug withdrawal due to adverse reactions by using Rev Man 5.2 statistical software. RESULTS：Totally 7 RCTs were included， involving 3 219 patients. Results of Meta-analyses indicated that the incidence of breakthrough invasive fungal infection [OR＝0.58， 95％CI（0.40，0.85），P＝0.004]，fungal infection mortality rate[OR＝0.68，95％CI（0.51，0.92），P＝0.01] and the incidence of drug withdrawal due to adverse reactions [OR＝0.52，95％CI（0.40，0.67），P＜0.001] in trial groups were significantly lower than control group，with statistical significance. There was no statistical significance in the all-cause mortality rate [OR＝0.84，95％CI（0.67， 1.05），P＝0.13]. CONCLUSIONS：Compared with amphotericin B and triazole antifungal agents，echinococcins used for the prevention of invasive candidiasis can reduce the incidence of breakthrough invasive fungal infection，fungal infection mortality rate and the incidence of drug withdrawal due to adverse reactions