title: 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.
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).
  
  
  CONCLUSIONS
  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).
authors.affiliation: Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto M5G 1X8, Ontario, Canada.
authors.forename: M C
authors.initials: MC
authors.lastname: Ethier
authors.forename: M
authors.initials: M
authors.lastname: Science
authors.forename: J
authors.initials: J
authors.lastname: Beyene
authors.forename: M
authors.initials: M
authors.lastname: Briel
authors.forename: T
authors.initials: T
authors.lastname: Lehrnbecher
authors.forename: L
authors.initials: L
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015725:Fluconazole / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D009369:Neoplasms / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; D015725:Fluconazole