title: Second- versus first-generation azoles for antifungal prophylaxis in hematology patients: a systematic review and meta-analysis.
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.
authors: Baohong Ping, Department of Huiqiao, Nanfang Hospital, Guangdong, Guangzhou, 510515, China. pingbh66@163.com
authors: Baohong
authors: B
authors: Ping
authors: Yangmin
authors: Y
authors: Zhu
authors: Ya
authors: Y
authors: Gao
authors: Chunyan
authors: C
authors: Yue
authors: Bin
authors: B
authors: Wu
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001228:Aspergillosis / Q000401:mortality / Q000517:prevention & control; D016469:Fungemia / Q000401:mortality / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009181:Mycoses / Q000401:mortality / Q000517:prevention & control*; D009503:Neutropenia / Q000150:complications / Q000209:etiology; D016017:Odds Ratio; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D019172:Transplantation Conditioning / Q000009:adverse effects; D016896:Treatment Outcome; D014230:Triazoles / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D014230:Triazoles