泊沙康唑预防侵袭性真菌感染有效性和安全性Meta分析
|
摘要
目的系统评价泊沙康唑预防侵袭性真菌感染的有效性与安全性。方法计算机检索PubMed,Embase,Cochrane Library数据库自建库至2018年6月的泊沙康唑预防侵袭性真菌感染的随机对照试验,采用RevMan 5. 0软件进行系统评价。结果共纳入4项研究。Meta分析结果显示,与氟康唑[OR=0. 43,95%CI(0. 28,0. 66),P=0. 000 1],伊曲康唑[OR=0. 74,95%CI(0. 23,2. 35),P=0. 61]或两性霉素B脂质体[OR=0. 17,95%CI(0. 01,3. 69),P=0. 26]相比,泊沙康唑预防侵袭性真菌感染效果更好,体现为更低的侵袭性真菌感染发病率、死亡率;泊沙康唑与唑类药物[OR=0. 91,95%CI(0. 73,1. 13),P=0. 37]或两性霉素B脂质体[OR=0. 54,95%CI(0. 13,2. 18),P=0. 39]不良反应发生率相似。结论与其他抗真菌药物相比,泊沙康唑预防侵袭性真菌感染的有效性及安全性较好。
Objective To systematically evaluate the efficacy and safety of posaconazole for the prevention of invasive fungal infections. Methods The randomized controlled trials about posaconazole for the prevention of invasive fungal infection were searched from PubMed,Embase and Cochrane Library since the inception to June 2018. The Meta-analysis was performed by RevMan 5. 0 software. Results A total of 4 randomized controlled trials were included in the study. Meta-analysis results showed that posaconazole was more effective in preventing invasive fungal infections than fluconazole [ OR = 0. 43,95% CI( 0. 28,0. 66),P = 0. 000 1 ],itraconazole[ OR = 0. 74,95% CI( 0. 23,2. 35),P = 0. 61 ] or amphotericin B liposomes [ OR = 0. 17,95% CI( 0. 01,3. 69),P = 0. 26 ],which reflected lower incidence of invasive fungal infections and lower mortality. The incidence of adverse reactions of posaconazole was similar to that of azoles [ OR = 0. 91,95% CI( 0. 73,1. 13),P = 0. 37 ] or amphotericin B liposomes [ OR = 0. 54,95% CI( 0. 13,2. 18),P = 0. 39 ].Conclusion Compared with other antifungal agents,posaconazole is more effective and safe in the prevention of invasive fungal infections.
Objective To systematically evaluate the efficacy and safety of posaconazole for the prevention of invasive fungal infections. Methods The randomized controlled trials about posaconazole for the prevention of invasive fungal infection were searched from PubMed,Embase and Cochrane Library since the inception to June 2018. The Meta-analysis was performed by RevMan 5. 0 software. Results A total of 4 randomized controlled trials were included in the study. Meta-analysis results showed that posaconazole was more effective in preventing invasive fungal infections than fluconazole [ OR = 0. 43,95% CI( 0. 28,0. 66),P = 0. 000 1 ],itraconazole[ OR = 0. 74,95% CI( 0. 23,2. 35),P = 0. 61 ] or amphotericin B liposomes [ OR = 0. 17,95% CI( 0. 01,3. 69),P = 0. 26 ],which reflected lower incidence of invasive fungal infections and lower mortality. The incidence of adverse reactions of posaconazole was similar to that of azoles [ OR = 0. 91,95% CI( 0. 73,1. 13),P = 0. 37 ] or amphotericin B liposomes [ OR = 0. 54,95% CI( 0. 13,2. 18),P = 0. 39 ].Conclusion Compared with other antifungal agents,posaconazole is more effective and safe in the prevention of invasive fungal infections.
引文
[1]NEWELL LF,HOLTAN SG.Placental growth factor:What hematologists need to know[J].Blood Rev,2017,31(1):57-62.
[2]BADIEE P,HASHEMIZADEH Z.Opportunistic invasive fungal infections:diagnosis&clinical management[J].Indian J Med Res,2014,139(2):195-204.
[3]GROLL AH,WALSH TJ.Posaconazole:clinical pharmacology and potential for management of fungal infections[J].Expert Rev Anti Infect Ther,2005,3(4):467-487.
[4]SABATELLI F,PATEL R,MANN PA,et al.In vitro activities of posaconazole,fluconazole,itraconazole,voriconazole,and amphotericin B against a large collection of clinically important molds and yeasts[J].AntimicrobAgentsChemother,2006,50(6):2009-2015.
[5]CLARK NM,GRIM SA,LYNCH JP 3RD.Posaconazole:Use in the Prophylaxis and Treatment of Fungal Infections[J].Semin Respir Crit Care Med,2015,36(5):767-785.
[6]MCKEAGE K.Posaconazole:a review of the gastro-resistant tablet and intravenous solution in invasive fungal infections[J].Drugs,2015,75(4):397-406.
[7]ULLMANN AJ,LIPTON JH,VESOLE DH,et al.Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease[J].New England Journal of Medicine,2007,356(4):335-347.
[8]CORNELY OA,MAERTENS J,WINSTON DJ,et al.Posaconazole vs.fluconazole or itraconazole prophylaxis in patients with neutropenia[J].N Engl J Med,2007,356(4):348-359.
[9]CHAFTARI AM,HACHEM RY,RAMOS E,et al.Comparison of posaconazole versus weekly amphotericin B lipid complex for the prevention of invasive fungal infections in hematopoietic stemcell transplantation[J].Transplantation,2012,94(3):302-308.
[10]SHEN Y,HUANG XJ,WANG JX,et al.Posaconazole vs.fluconazole as invasive fungal infection prophylaxis in China:a multicenter,randomized,open-label study[J].International Journal of Clinical Pharmacology and Therapeutics,2013,51(9):738-745.
[11]JADAD AR,MOORE RA,CARROLL D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J].Control Clin Trials,1996,17(1):1-12.
[12]SAHIN SZ,AKALIN H,ERSOY A,et al.Invasive Fungal Infections in Renal Transplant Recipients:Epidemiology and Risk Factors[J].Mycopathologia,2015,180(1-2):43-50.
[13]PING B,ZHU Y,GAO Y,et al.Second-versus first-generation azoles for antifungal prophylaxis in hematology patients:a systematic review and meta-analysis[J].Ann Hematol,2013,92(6):831-839.
[14]SUNG AH,MARCELLA SW,XIE Y.An update to the costeffectiveness of posaconazole vs fluconazole or itraconazole in the prevention of invasive fungal disease among neutropenic patients in the United States[J].J Med Econ,2015,18(5):341-348.
[15]KUNG HC,JOHNSON MD,DREW RH,et al.Clinical effectiveness of posaconazole versus fluconazole as antifungal prophylaxis in hematology-oncology patients:a retrospective cohort study[J].Cancer Med,2014,3(3):667-673.
[16]HACHEM R,ASSAF A,NUMAN Y,et al.Comparing the safety and efficacy of voriconazole versus posaconazole in the prevention of invasive fungal infections in high-risk patients with hematological malignancies[J].Int J Antimicrob Agents,2017,50(3):384-388.
[17]RAAD II,HANNA HA,BOKTOUR M,et al.Novel antifungal agents as salvage therapy for invasive aspergillosis in patients with hematologic malignancies:posaconazole compared with highdose lipid formulations of amphotericin B alone or in combination with caspofungin[J].Leukemia,2008,22(3):496-503.
[18]MOORE JN,HEALY JR,KRAFT WK.Pharmacologic and clinical evaluation of posaconazole[J].Expert Rev Clin Pharmacol,2015,8(3):321-334.
[19]CHAU MM,KONG DC,VAN HAL SJ,et al.Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy,2014[J].Intern Med J,2014,44(12b):1364-1388.
[20]GEDIK H.The expenditures related to the use of antifungal drugs in patients with hematological cancers:a cost analysis[J].Clinicoecon Outcomes Res,2015,7:537-543.
[2]BADIEE P,HASHEMIZADEH Z.Opportunistic invasive fungal infections:diagnosis&clinical management[J].Indian J Med Res,2014,139(2):195-204.
[3]GROLL AH,WALSH TJ.Posaconazole:clinical pharmacology and potential for management of fungal infections[J].Expert Rev Anti Infect Ther,2005,3(4):467-487.
[4]SABATELLI F,PATEL R,MANN PA,et al.In vitro activities of posaconazole,fluconazole,itraconazole,voriconazole,and amphotericin B against a large collection of clinically important molds and yeasts[J].AntimicrobAgentsChemother,2006,50(6):2009-2015.
[5]CLARK NM,GRIM SA,LYNCH JP 3RD.Posaconazole:Use in the Prophylaxis and Treatment of Fungal Infections[J].Semin Respir Crit Care Med,2015,36(5):767-785.
[6]MCKEAGE K.Posaconazole:a review of the gastro-resistant tablet and intravenous solution in invasive fungal infections[J].Drugs,2015,75(4):397-406.
[7]ULLMANN AJ,LIPTON JH,VESOLE DH,et al.Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease[J].New England Journal of Medicine,2007,356(4):335-347.
[8]CORNELY OA,MAERTENS J,WINSTON DJ,et al.Posaconazole vs.fluconazole or itraconazole prophylaxis in patients with neutropenia[J].N Engl J Med,2007,356(4):348-359.
[9]CHAFTARI AM,HACHEM RY,RAMOS E,et al.Comparison of posaconazole versus weekly amphotericin B lipid complex for the prevention of invasive fungal infections in hematopoietic stemcell transplantation[J].Transplantation,2012,94(3):302-308.
[10]SHEN Y,HUANG XJ,WANG JX,et al.Posaconazole vs.fluconazole as invasive fungal infection prophylaxis in China:a multicenter,randomized,open-label study[J].International Journal of Clinical Pharmacology and Therapeutics,2013,51(9):738-745.
[11]JADAD AR,MOORE RA,CARROLL D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J].Control Clin Trials,1996,17(1):1-12.
[12]SAHIN SZ,AKALIN H,ERSOY A,et al.Invasive Fungal Infections in Renal Transplant Recipients:Epidemiology and Risk Factors[J].Mycopathologia,2015,180(1-2):43-50.
[13]PING B,ZHU Y,GAO Y,et al.Second-versus first-generation azoles for antifungal prophylaxis in hematology patients:a systematic review and meta-analysis[J].Ann Hematol,2013,92(6):831-839.
[14]SUNG AH,MARCELLA SW,XIE Y.An update to the costeffectiveness of posaconazole vs fluconazole or itraconazole in the prevention of invasive fungal disease among neutropenic patients in the United States[J].J Med Econ,2015,18(5):341-348.
[15]KUNG HC,JOHNSON MD,DREW RH,et al.Clinical effectiveness of posaconazole versus fluconazole as antifungal prophylaxis in hematology-oncology patients:a retrospective cohort study[J].Cancer Med,2014,3(3):667-673.
[16]HACHEM R,ASSAF A,NUMAN Y,et al.Comparing the safety and efficacy of voriconazole versus posaconazole in the prevention of invasive fungal infections in high-risk patients with hematological malignancies[J].Int J Antimicrob Agents,2017,50(3):384-388.
[17]RAAD II,HANNA HA,BOKTOUR M,et al.Novel antifungal agents as salvage therapy for invasive aspergillosis in patients with hematologic malignancies:posaconazole compared with highdose lipid formulations of amphotericin B alone or in combination with caspofungin[J].Leukemia,2008,22(3):496-503.
[18]MOORE JN,HEALY JR,KRAFT WK.Pharmacologic and clinical evaluation of posaconazole[J].Expert Rev Clin Pharmacol,2015,8(3):321-334.
[19]CHAU MM,KONG DC,VAN HAL SJ,et al.Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy,2014[J].Intern Med J,2014,44(12b):1364-1388.
[20]GEDIK H.The expenditures related to the use of antifungal drugs in patients with hematological cancers:a cost analysis[J].Clinicoecon Outcomes Res,2015,7:537-543.