Systematic review and mixed treatment comparison meta-analysis of randomized clinical trials of primary oral antifungal prophylaxis in allogeneic hematopoietic cell transplant recipients
Identifieur interne : 002782 ( Main/Exploration ); précédent : 002781; suivant : 002783Systematic review and mixed treatment comparison meta-analysis of randomized clinical trials of primary oral antifungal prophylaxis in allogeneic hematopoietic cell transplant recipients
Auteurs : Eric J. Bow ; David J. Vanness ; Monica Slavin [Australie] ; Catherine Cordonnier [France] ; Oliver A. Cornely [Allemagne] ; David I. Marks [Royaume-Uni] ; Antonio Pagliuca [Royaume-Uni] ; Carlos Solano [Espagne] ; Lael Cragin ; Alissa J. Shaul ; Sonja Sorensen ; Richard Chambers ; Michal Kantecki [France] ; David Weinstein [France] ; Haran Schlamm [États-Unis]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2015.
Descripteurs français
- KwdFr :
- MESH :
- traitement médicamenteux : Mycoses.
- usage thérapeutique : Antifongiques.
- Essais contrôlés randomisés comme sujet, Humains, Mycoses, Receveurs de transplantation, Théorème de Bayes, Transplantation de cellules souches hématopoïétiques.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Antifungal Agents.
- drug therapy : Mycoses.
- prevention & control : Mycoses.
- Bayes Theorem, Hematopoietic Stem Cell Transplantation, Humans, Randomized Controlled Trials as Topic, Transplant Recipients.
Abstract
Antifungal prophylaxis is a promising strategy for reducing invasive fungal infections (IFIs) in allogeneic hematopoietic cell transplant (alloHCT) recipients, but the optimum prophylactic agent is unknown. We used mixed treatment comparison (MTC) meta-analysis to compare clinical trials examining the use of oral antifungals for prophylaxis in alloHCT recipients, with the goal of informing medical decision-making.
Randomized controlled trials (RCTs) of fluconazole, itraconazole, posaconazole, and voriconazole for primary antifungal prophylaxis were identified through a systematic literature review. Outcomes of interest (incidence of IFI/invasive aspergillosis/invasive candidiasis, all-cause mortality, and use of other antifungals) were extracted from eligible RCTs and incorporated into a Bayesian hierarchical random-effects MTC.
Five eligible RCTs, randomizing 2147 patients in total, were included. Relative to fluconazole, prophylaxis with itraconazole (odds ratio [OR]: 0.52; interquartile range [IQR]: 0.35–0.76), posaconazole (OR: 0.56; IQR: 0.32–0.99), and voriconazole (OR: 0.46; IQR: 0.28–0.73) reduced incidence of overall proven/probable IFI. Posaconazole (OR: 0.31; IQR: 0.17–0.58) and voriconazole (OR: 0.33; IQR: 0.17–0.58) prophylaxis reduced proven/probable invasive aspergillosis more than itraconazole (OR: 0.68; IQR: 0.42–1.12). All-cause mortality was similar across all mould-active agents.
As expected, mould-active azoles prevented IFIs, particularly invasive aspergillosis, more effectively than fluconazole in alloHCT recipients. The paucity of comparative efficacy data suggests that other factors such as long-term tolerability, availability of intravenous formulations, local IFI epidemiology, and drug costs may need to form the basis for selection among the mould-active azoles.
The online version of this article (doi:10.1186/s12879-015-0855-6) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12879-015-0855-6
PubMed: 25887385
PubMed Central: 4374298
Affiliations:
- Allemagne, Australie, Espagne, France, Royaume-Uni, États-Unis
- Angleterre, Grand Londres, Victoria (État), État de New York, Île-de-France
- Créteil, Londres, Melbourne, New York, Paris
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Le document en format XML
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<term>Hematopoietic Stem Cell Transplantation</term>
<term>Humans</term>
<term>Mycoses (drug therapy)</term>
<term>Mycoses (prevention & control)</term>
<term>Randomized Controlled Trials as Topic</term>
<term>Transplant Recipients</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Antifongiques (usage thérapeutique)</term>
<term>Essais contrôlés randomisés comme sujet</term>
<term>Humains</term>
<term>Mycoses ()</term>
<term>Mycoses (traitement médicamenteux)</term>
<term>Receveurs de transplantation</term>
<term>Théorème de Bayes</term>
<term>Transplantation de cellules souches hématopoïétiques</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antifungal Agents</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Mycoses</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Mycoses</term>
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<keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Mycoses</term>
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</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Bayes Theorem</term>
<term>Hematopoietic Stem Cell Transplantation</term>
<term>Humans</term>
<term>Randomized Controlled Trials as Topic</term>
<term>Transplant Recipients</term>
</keywords>
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<term>Humains</term>
<term>Mycoses</term>
<term>Receveurs de transplantation</term>
<term>Théorème de Bayes</term>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Antifungal prophylaxis is a promising strategy for reducing invasive fungal infections (IFIs) in allogeneic hematopoietic cell transplant (alloHCT) recipients, but the optimum prophylactic agent is unknown. We used mixed treatment comparison (MTC) meta-analysis to compare clinical trials examining the use of oral antifungals for prophylaxis in alloHCT recipients, with the goal of informing medical decision-making.</p>
</sec>
<sec><title>Methods</title>
<p>Randomized controlled trials (RCTs) of fluconazole, itraconazole, posaconazole, and voriconazole for primary antifungal prophylaxis were identified through a systematic literature review. Outcomes of interest (incidence of IFI/invasive aspergillosis/invasive candidiasis, all-cause mortality, and use of other antifungals) were extracted from eligible RCTs and incorporated into a Bayesian hierarchical random-effects MTC.</p>
</sec>
<sec><title>Results</title>
<p>Five eligible RCTs, randomizing 2147 patients in total, were included. Relative to fluconazole, prophylaxis with itraconazole (odds ratio [OR]: 0.52; interquartile range [IQR]: 0.35–0.76), posaconazole (OR: 0.56; IQR: 0.32–0.99), and voriconazole (OR: 0.46; IQR: 0.28–0.73) reduced incidence of overall proven/probable IFI. Posaconazole (OR: 0.31; IQR: 0.17–0.58) and voriconazole (OR: 0.33; IQR: 0.17–0.58) prophylaxis reduced proven/probable invasive aspergillosis more than itraconazole (OR: 0.68; IQR: 0.42–1.12). All-cause mortality was similar across all mould-active agents.</p>
</sec>
<sec><title>Conclusion</title>
<p>As expected, mould-active azoles prevented IFIs, particularly invasive aspergillosis, more effectively than fluconazole in alloHCT recipients. The paucity of comparative efficacy data suggests that other factors such as long-term tolerability, availability of intravenous formulations, local IFI epidemiology, and drug costs may need to form the basis for selection among the mould-active azoles.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12879-015-0855-6) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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<biblStruct><analytic><author><name sortKey="Claxton, K" uniqKey="Claxton K">K Claxton</name>
</author>
</analytic>
</biblStruct>
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</author>
<author><name sortKey="Mccloskey, Dn" uniqKey="Mccloskey D">DN McCloskey</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Carlin, Bp" uniqKey="Carlin B">BP Carlin</name>
</author>
<author><name sortKey="Louis, Ta" uniqKey="Louis T">TA Louis</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Wang, J" uniqKey="Wang J">J Wang</name>
</author>
<author><name sortKey="Zhan, P" uniqKey="Zhan P">P Zhan</name>
</author>
<author><name sortKey="Zhou, R" uniqKey="Zhou R">R Zhou</name>
</author>
<author><name sortKey="Xu, J" uniqKey="Xu J">J Xu</name>
</author>
<author><name sortKey="Shao, X" uniqKey="Shao X">X Shao</name>
</author>
<author><name sortKey="Yang, Y" uniqKey="Yang Y">Y Yang</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Blennow, O" uniqKey="Blennow O">O Blennow</name>
</author>
<author><name sortKey="Remberger, M" uniqKey="Remberger M">M Remberger</name>
</author>
<author><name sortKey="Klingspor, L" uniqKey="Klingspor L">L Klingspor</name>
</author>
<author><name sortKey="Omazic, B" uniqKey="Omazic B">B Omazic</name>
</author>
<author><name sortKey="Fransson, K" uniqKey="Fransson K">K Fransson</name>
</author>
<author><name sortKey="Ljungman, P" uniqKey="Ljungman P">P Ljungman</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="De Pauw, B" uniqKey="De Pauw B">B de Pauw</name>
</author>
<author><name sortKey="Walsh, Tj" uniqKey="Walsh T">TJ Walsh</name>
</author>
<author><name sortKey="Donnelly, Jp" uniqKey="Donnelly J">JP Donnelly</name>
</author>
<author><name sortKey="Stevens, Da" uniqKey="Stevens D">DA Stevens</name>
</author>
<author><name sortKey="Edwards, Je" uniqKey="Edwards J">JE Edwards</name>
</author>
<author><name sortKey="Calandra, T" uniqKey="Calandra T">T Calandra</name>
</author>
</analytic>
</biblStruct>
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</author>
<author><name sortKey="Patterson, Tf" uniqKey="Patterson T">TF Patterson</name>
</author>
<author><name sortKey="Slavin, Ma" uniqKey="Slavin M">MA Slavin</name>
</author>
<author><name sortKey="Marchetti, O" uniqKey="Marchetti O">O Marchetti</name>
</author>
<author><name sortKey="Maertens, J" uniqKey="Maertens J">J Maertens</name>
</author>
<author><name sortKey="Johnson, Em" uniqKey="Johnson E">EM Johnson</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Segal, Bh" uniqKey="Segal B">BH Segal</name>
</author>
<author><name sortKey="Herbrecht, R" uniqKey="Herbrecht R">R Herbrecht</name>
</author>
<author><name sortKey="Stevens, Da" uniqKey="Stevens D">DA Stevens</name>
</author>
<author><name sortKey="Ostrosky Zeichner, L" uniqKey="Ostrosky Zeichner L">L Ostrosky-Zeichner</name>
</author>
<author><name sortKey="Sobel, J" uniqKey="Sobel J">J Sobel</name>
</author>
<author><name sortKey="Viscoli, C" uniqKey="Viscoli C">C Viscoli</name>
</author>
</analytic>
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</TEI>
<affiliations><list><country><li>Allemagne</li>
<li>Australie</li>
<li>Espagne</li>
<li>France</li>
<li>Royaume-Uni</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Grand Londres</li>
<li>Victoria (État)</li>
<li>État de New York</li>
<li>Île-de-France</li>
</region>
<settlement><li>Créteil</li>
<li>Londres</li>
<li>Melbourne</li>
<li>New York</li>
<li>Paris</li>
</settlement>
</list>
<tree><noCountry><name sortKey="Bow, Eric J" sort="Bow, Eric J" uniqKey="Bow E" first="Eric J" last="Bow">Eric J. Bow</name>
<name sortKey="Chambers, Richard" sort="Chambers, Richard" uniqKey="Chambers R" first="Richard" last="Chambers">Richard Chambers</name>
<name sortKey="Cragin, Lael" sort="Cragin, Lael" uniqKey="Cragin L" first="Lael" last="Cragin">Lael Cragin</name>
<name sortKey="Shaul, Alissa J" sort="Shaul, Alissa J" uniqKey="Shaul A" first="Alissa J" last="Shaul">Alissa J. Shaul</name>
<name sortKey="Sorensen, Sonja" sort="Sorensen, Sonja" uniqKey="Sorensen S" first="Sonja" last="Sorensen">Sonja Sorensen</name>
<name sortKey="Vanness, David J" sort="Vanness, David J" uniqKey="Vanness D" first="David J" last="Vanness">David J. Vanness</name>
</noCountry>
<country name="Australie"><region name="Victoria (État)"><name sortKey="Slavin, Monica" sort="Slavin, Monica" uniqKey="Slavin M" first="Monica" last="Slavin">Monica Slavin</name>
</region>
</country>
<country name="France"><region name="Île-de-France"><name sortKey="Cordonnier, Catherine" sort="Cordonnier, Catherine" uniqKey="Cordonnier C" first="Catherine" last="Cordonnier">Catherine Cordonnier</name>
</region>
<name sortKey="Kantecki, Michal" sort="Kantecki, Michal" uniqKey="Kantecki M" first="Michal" last="Kantecki">Michal Kantecki</name>
<name sortKey="Weinstein, David" sort="Weinstein, David" uniqKey="Weinstein D" first="David" last="Weinstein">David Weinstein</name>
</country>
<country name="Allemagne"><noRegion><name sortKey="Cornely, Oliver A" sort="Cornely, Oliver A" uniqKey="Cornely O" first="Oliver A" last="Cornely">Oliver A. Cornely</name>
</noRegion>
</country>
<country name="Royaume-Uni"><noRegion><name sortKey="Marks, David I" sort="Marks, David I" uniqKey="Marks D" first="David I" last="Marks">David I. Marks</name>
</noRegion>
<name sortKey="Pagliuca, Antonio" sort="Pagliuca, Antonio" uniqKey="Pagliuca A" first="Antonio" last="Pagliuca">Antonio Pagliuca</name>
</country>
<country name="Espagne"><noRegion><name sortKey="Solano, Carlos" sort="Solano, Carlos" uniqKey="Solano C" first="Carlos" last="Solano">Carlos Solano</name>
</noRegion>
</country>
<country name="États-Unis"><region name="État de New York"><name sortKey="Schlamm, Haran" sort="Schlamm, Haran" uniqKey="Schlamm H" first="Haran" last="Schlamm">Haran Schlamm</name>
</region>
</country>
</tree>
</affiliations>
</record>
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