A systematic review and meta‐analysis of efficacy and safety of isavuconazole for the treatment and prophylaxis of invasive fungal infections

泊沙康唑 中止 医学 内科学 氟康唑 不利影响 伏立康唑 伊曲康唑 两性霉素B 荟萃分析 入射(几何) 优势比 死亡率 氟胞嘧啶 抗真菌 皮肤病科 物理 光学
作者
Hideo Kato,Mao Hagihara,Nobuhiro Asai,Takumi Umemura,Jun Hirai,N. Môri,Yuka Yamagishi,Takuya Iwamoto,Hiroshige Mikamo
出处
期刊:Mycoses [Wiley]
卷期号:66 (9): 815-824 被引量:11
标识
DOI:10.1111/myc.13622
摘要

Abstract Background Isavuconazole is a novel triazole antifungal agent. However, the previous outcomes were highlighted by statistical heterogeneity. This meta‐analysis aimed to validate the efficacy and safety of isavuconazole for the treatment and prophylaxis of invasive fungal infections (IFIs) compared with other antifungal agents (amphotericin B, voriconazole and posaconazole). Methods Scopus, EMBASE, PubMed, CINAHL and Ichushi databases were searched for relevant articles that met the inclusion criteria through February 2023. Mortality, IFI rate, discontinuation rate of antifungal therapy and incidence of abnormal hepatic function were evaluated. The discontinuation rate was defined as the percentage of therapy discontinuations due to adverse events. The control group included patients who received other antifungal agents. Results Of the 1784 citations identified for screening, 10 studies with an overall total of 3037 patients enrolled. Isavuconazole was comparable with the control group in mortality and IFI rate in the treatment and prophylaxis of IFIs, respectively (mortality, odds rate (OR) 1.11, 95% confidential interval (CI) 0.82–1.51; IFI rate, OR 1.02, 95% CI 0.49–2.12). Isavuconazole significantly reduced the discontinuation rate in the treatment (OR 1.96, 95% CI 1.26–3.07) and incidence of hepatic function abnormalities in the treatment and prophylaxis, compared with the control group (treatment, OR 2.31, 95% CI 1.41–3.78; prophylaxis, OR 3.63, 95% CI 1.31–10.05). Conclusions Our meta‐analysis revealed that isavuconazole was not inferior to other antifungal agents for the treatment and prophylaxis of IFIs, with substantially fewer drug‐associated adverse events and discontinuations. Our findings support the use of isavuconazole as the primary treatment and prophylaxis for IFIs.
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