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Comparative effectiveness of antifungal agents in patients with hematopoietic stem cell transplantation: a systematic review and network meta-analysis

Authors Su HC, Hua YM, Feng IJ, Wu HC

Received 30 January 2019

Accepted for publication 24 April 2019

Published 15 May 2019 Volume 2019:12 Pages 1311—1324

DOI https://doi.org/10.2147/IDR.S203579

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Dr Sahil Khanna


Hui-Chen Su,1,* Yi-Ming Hua,1,* I Jung Feng,2 Hung-Chang Wu3

1Department of Pharmacy, Chi Mei Medical Center, Tainan City, Taiwan; 2Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan; 3Division of Hematology-Oncology, Department of Internal medicine, Chi Mei Medical Center, Tainan City, Taiwan

*These authors contributed equally to this work

Purpose:
The aim of this study was to use a network meta-analysis to evaluate the relative efficacy of various agents at preventing invasive fungal infections (IFIs). In this way, suitable prophylactic regimens may be selected for patients with hematopoietic stem cell transplantation (HSCT).
Methods: We conducted a systematic review of randomized controlled trials comparing the prophylactic effects of two antifungal agents or an antifungal agent and a placebo administered to patients with HSCT. Relevant studies were found in the PubMed and Cochrane databases. Unpublished studies were collected from the ClinicalTrials.gov registry.
Results: Sixteen two-arm studies were identified. Compared with placebo, all six antifungal agents (amphotericin B, fluconazole, itraconazole, micafungin, posaconazole, and voriconazole) presented with greater efficacy at controlling proven IFIs. OR ranged from 0.08 to 0.29. Voriconazole (surface under the cumulative ranking curve [SUCRA]=71.6%), posaconazole (SUCRA=68.9%), and itraconazole (SUCRA=64.7%) were the three top-ranking drugs for preventing proven IFIs. Itraconazole ranked highest (SUCRA=83.1%) and had the greatest efficacy at preventing invasive candidiasis. Posaconazole and micafungin were the two top-ranking drugs (SUCRA=81.3% and 78.4%, respectively) at preventing invasive aspergillosis. Micafungin and voriconazole were the drugs of choice because they lowered mortality more than the other agents (SUCRA=74.6% and 61.1%, respectively).
Conclusion: This study is the first network meta-analysis to explore the prophylactic effects of antifungal agents in patients with HSCT. Voriconazole was the best choice for the prevention of proven IFIs in HSCT patients.

Keywords: antifungal agents, hematopoietic stem cell transplantation, network meta-analysis

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