Mould-active compared with fluconazole prophylaxis to prevent invasive fungal diseases in cancer patients receiving chemotherapy or haematopoietic stem-cell transplantation: a systematic review and meta-analysis of randomised controlled trials.
Br J Cancer 2012;
106:1626-37. [PMID:
22568999 PMCID:
PMC3349180 DOI:
10.1038/bjc.2012.147]
[Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background:
Objectives were to compare systemic mould-active vs fluconazole
prophylaxis in cancer patients receiving chemotherapy or haematopoietic stem
cell transplantation (HSCT).
Methods:
We searched OVID MEDLINE and the Cochrane Central Register of Controlled
Trials (1948-August 2011) and EMBASE (1980-August 2011). Randomised
controlled trials of mould-active vs fluconazole prophylaxis in
cancer or HSCT patients were included. Primary outcome was
proven/probable invasive fungal infections (IFI). Analysis was completed
by computing relative risks (RRs) using a random-effects model and
Mantel–Haenszel method.
Results:
From 984 reviewed articles, 20 were included in this review. Mould-active
compared with fluconazole prophylaxis significantly reduced the number of
proven/probable IFI (RR 0.71, 95% CI 0.52 to 0.98;
P=0.03). Mould-active prophylaxis also decreased the risk of
invasive aspergillosis (IA; RR 0.53, 95% confidence interval (CI)
0.37–0.75; P=0.0004) and IFI-related mortality (RR
0.67, 95% CI 0.47–0.96; P=0.03) but is also
associated with an increased risk of adverse events (AEs) leading to
antifungal discontinuation (RR 1.95, 95% CI 1.24–3.07;
P=0.004). There was no decrease in overall mortality (RR
1.0; 95% CI 0.88–1.13; P=0.96).
Conclusion:
Mould-active compared with fluconazole prophylaxis significantly reduces
proven/probable IFI, IA, and IFI-related mortality in cancer patients
receiving chemotherapy or HSCT, but increases AE and does not affect overall
mortality.(PROSPERO Registration: CRD420111174)
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