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Second- versus first-generation azoles for antifungal prophylaxis in hematology patients: a systematic review and meta-analysis.
- Source :
-
Annals of hematology [Ann Hematol] 2013 Jun; Vol. 92 (6), pp. 831-9. Date of Electronic Publication: 2013 Feb 28. - Publication Year :
- 2013
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Abstract
- Second-generation azoles may be more effective than first-generation azoles in the prevention of fungal infections in hematology patients. We performed a systematic review with meta-analysis of randomized controlled trials comparing second- with first-generation azoles in hematology patients with respect to proven or probable invasive fungal infections, invasive aspergillosis, receipt of empirical antifungal therapy, overall mortality, and withdrawal from the studies due to the development of adverse effects. We searched the Medline, Embase, and Cochrane Registry of Controlled Trials electronic databases as well as conference proceedings from 2002 to 2012 for randomized controlled trials comparing second-generation azoles (voriconazole, posaconazole) versus first-generation azoles (fluconazole, itraconazole). Treatment effect measures for all outcomes were expressed as odds ratio with 95 % confidence interval. Meta-analysis was performed using Review Manager, version 5.1. Data from four randomized clinical trials representing a large population of patients demonstrated that antifungal prophylaxis with second-generation azoles reduces proven or probable invasive fungal infections, invasive aspergillosis, and receipt of empirical antifungal therapy in high-risk hematology patients, while there were no differences between second- and first-generation azoles with regard to overall mortality and patients or withdrawal from the studies due to the development of adverse effects. In conclusion, antifungal prophylaxis with second-generation azoles can significantly reduce the incidence of invasive fungal infections and invasive aspergillosis but with no risk of an increase in adverse events.
- Subjects :
- Antineoplastic Agents adverse effects
Aspergillosis mortality
Aspergillosis prevention & control
Fungemia mortality
Fungemia prevention & control
Hematologic Neoplasms therapy
Hematopoietic Stem Cell Transplantation
Humans
Immunocompromised Host
Immunosuppressive Agents adverse effects
Immunosuppressive Agents therapeutic use
Multicenter Studies as Topic statistics & numerical data
Mycoses mortality
Neutropenia complications
Neutropenia etiology
Odds Ratio
Patient Dropouts statistics & numerical data
Prospective Studies
Randomized Controlled Trials as Topic statistics & numerical data
Transplantation Conditioning adverse effects
Treatment Outcome
Triazoles adverse effects
Triazoles classification
Antifungal Agents therapeutic use
Hematologic Neoplasms complications
Mycoses prevention & control
Triazoles therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1432-0584
- Volume :
- 92
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Annals of hematology
- Publication Type :
- Academic Journal
- Accession number :
- 23455400
- Full Text :
- https://doi.org/10.1007/s00277-013-1693-5