Fluconazole versus itraconazole for antifungal prophylaxis in neutropenic patients with haematological malignancies: a meta‐analysis of randomised‐controlled trials
Summary Fluconazole and itraconazole are used as antifungal prophylaxis in neutropenic patients with haematological malignancies. A meta‐analysis of randomised‐controlled trials (RCTs) was performed in order to compare their safety and effectiveness in this population. Data were obtained from PubMed...
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| Veröffentlicht in: | British journal of haematology 2005-10, Vol.131 (1), p.22-28 |
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| creator | Vardakas, Konstantinos Z. Michalopoulos, Argyris Falagas, Matthew E. |
| description | Summary
Fluconazole and itraconazole are used as antifungal prophylaxis in neutropenic patients with haematological malignancies. A meta‐analysis of randomised‐controlled trials (RCTs) was performed in order to compare their safety and effectiveness in this population. Data were obtained from PubMed, Current Contents, Cochrane Central Register for Controlled Trials and references from relevant articles. Five RCTs were included in the analysis. Publication bias and statistically significant heterogeneity was not observed among the analysed studies. Fewer patients were withdrawn due to the development of adverse effects associated with fluconazole when compared with itraconazole [odds ratio (OR) = 0·27, 95% confidence interval (CI): 0·18–0·41]. On the contrary, prophylactic use of fluconazole resulted in significantly more fungal infections (documented and suspected infections combined, OR = 1·62, 95% CI: 1·06–2·48). There were no statistically significant differences regarding documented fungal infections (OR = 1·51, 95% CI: 0·97–2·35), invasive fungal infections (OR = 1·44, 95% CI: 0·96–2·17), overall mortality (OR = 0·89, 95% CI: 0·63–1·24) and mortality attributed by the authors to fungal infections (OR = 1·30, 95% CI: 0·75–2·25) between the two medications. These data suggest that, even though itraconazole is more effective than fluconazole in the prevention of fungal infections in neutropenic patients with haematological malignancies, the development of more adverse effects may limit its use. |
| doi_str_mv | 10.1111/j.1365-2141.2005.05727.x |
| format | Article |
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Fluconazole and itraconazole are used as antifungal prophylaxis in neutropenic patients with haematological malignancies. A meta‐analysis of randomised‐controlled trials (RCTs) was performed in order to compare their safety and effectiveness in this population. Data were obtained from PubMed, Current Contents, Cochrane Central Register for Controlled Trials and references from relevant articles. Five RCTs were included in the analysis. Publication bias and statistically significant heterogeneity was not observed among the analysed studies. Fewer patients were withdrawn due to the development of adverse effects associated with fluconazole when compared with itraconazole [odds ratio (OR) = 0·27, 95% confidence interval (CI): 0·18–0·41]. On the contrary, prophylactic use of fluconazole resulted in significantly more fungal infections (documented and suspected infections combined, OR = 1·62, 95% CI: 1·06–2·48). There were no statistically significant differences regarding documented fungal infections (OR = 1·51, 95% CI: 0·97–2·35), invasive fungal infections (OR = 1·44, 95% CI: 0·96–2·17), overall mortality (OR = 0·89, 95% CI: 0·63–1·24) and mortality attributed by the authors to fungal infections (OR = 1·30, 95% CI: 0·75–2·25) between the two medications. These data suggest that, even though itraconazole is more effective than fluconazole in the prevention of fungal infections in neutropenic patients with haematological malignancies, the development of more adverse effects may limit its use.</description><identifier>ISSN: 0007-1048</identifier><identifier>EISSN: 1365-2141</identifier><identifier>DOI: 10.1111/j.1365-2141.2005.05727.x</identifier><identifier>PMID: 16173959</identifier><identifier>CODEN: BJHEAL</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>amphotericin B ; Antifungal Agents - therapeutic use ; Biological and medical sciences ; Chi-Square Distribution ; clotrimazole ; Fluconazole - therapeutic use ; Hematologic and hematopoietic diseases ; Hematologic Neoplasms - microbiology ; Hematology ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunocompromised Host ; Itraconazole - therapeutic use ; ketoconazole ; Medical sciences ; miconazole ; Mycoses - complications ; Mycoses - prevention & control ; Neutropenia ; Opportunistic Infections - microbiology ; Opportunistic Infections - prevention & control ; Other diseases. Hematologic involvement in other diseases ; prevention ; Randomized Controlled Trials as Topic ; Survival Analysis</subject><ispartof>British journal of haematology, 2005-10, Vol.131 (1), p.22-28</ispartof><rights>2005 INIST-CNRS</rights><rights>Copyright Blackwell Publishing Oct 2005</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4747-fb296d1c9a8ae0924bd9e482fcd4610a1b1cc105a238633735113fea6d3749e53</citedby><cites>FETCH-LOGICAL-c4747-fb296d1c9a8ae0924bd9e482fcd4610a1b1cc105a238633735113fea6d3749e53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-2141.2005.05727.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-2141.2005.05727.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17108274$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16173959$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vardakas, Konstantinos Z.</creatorcontrib><creatorcontrib>Michalopoulos, Argyris</creatorcontrib><creatorcontrib>Falagas, Matthew E.</creatorcontrib><title>Fluconazole versus itraconazole for antifungal prophylaxis in neutropenic patients with haematological malignancies: a meta‐analysis of randomised‐controlled trials</title><title>British journal of haematology</title><addtitle>Br J Haematol</addtitle><description>Summary
Fluconazole and itraconazole are used as antifungal prophylaxis in neutropenic patients with haematological malignancies. A meta‐analysis of randomised‐controlled trials (RCTs) was performed in order to compare their safety and effectiveness in this population. Data were obtained from PubMed, Current Contents, Cochrane Central Register for Controlled Trials and references from relevant articles. Five RCTs were included in the analysis. Publication bias and statistically significant heterogeneity was not observed among the analysed studies. Fewer patients were withdrawn due to the development of adverse effects associated with fluconazole when compared with itraconazole [odds ratio (OR) = 0·27, 95% confidence interval (CI): 0·18–0·41]. On the contrary, prophylactic use of fluconazole resulted in significantly more fungal infections (documented and suspected infections combined, OR = 1·62, 95% CI: 1·06–2·48). There were no statistically significant differences regarding documented fungal infections (OR = 1·51, 95% CI: 0·97–2·35), invasive fungal infections (OR = 1·44, 95% CI: 0·96–2·17), overall mortality (OR = 0·89, 95% CI: 0·63–1·24) and mortality attributed by the authors to fungal infections (OR = 1·30, 95% CI: 0·75–2·25) between the two medications. These data suggest that, even though itraconazole is more effective than fluconazole in the prevention of fungal infections in neutropenic patients with haematological malignancies, the development of more adverse effects may limit its use.</description><subject>amphotericin B</subject><subject>Antifungal Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Chi-Square Distribution</subject><subject>clotrimazole</subject><subject>Fluconazole - therapeutic use</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hematologic Neoplasms - microbiology</subject><subject>Hematology</subject><subject>Hematopoietic Stem Cell Transplantation</subject><subject>Humans</subject><subject>Immunocompromised Host</subject><subject>Itraconazole - therapeutic use</subject><subject>ketoconazole</subject><subject>Medical sciences</subject><subject>miconazole</subject><subject>Mycoses - complications</subject><subject>Mycoses - prevention & control</subject><subject>Neutropenia</subject><subject>Opportunistic Infections - microbiology</subject><subject>Opportunistic Infections - prevention & control</subject><subject>Other diseases. Hematologic involvement in other diseases</subject><subject>prevention</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Survival Analysis</subject><issn>0007-1048</issn><issn>1365-2141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkcGO0zAQhiMEYsvCKyALCW4NduzECRIHWLEsaCUucLamzqR15djFdtiWE4_AY_BcPAkOrXYlTvgy1vib3zPzFwVhtGT5vNyWjDf1smKClRWldUlrWclyf69Y3D7cLxaUUrlkVLRnxaMYt5QyTmv2sDhjDZO8q7tF8evSTto7-O4tkm8Y4hSJSQFuc4MPBFwyw-TWYMku-N3mYGFvMueIwynlDDqjyQ6SQZciuTFpQzaAIyRv_droXDeCNWsHThuMrwiQERP8_vETHNhDzFp-IAFc70cTsc8P-f8sbC32JAUDNj4uHgw54JNTPC--XL77fHG1vP70_sPFm-ulFlLI5bCquqZnuoMWkHaVWPUdirYadC8aRoGtmNaM1lDxtuFc8poxPiA0PZeiw5qfFy-OunnSrxPGpHJLGq0Fh36KqmmbvEMqM_jsH3Drp5DniYp1bd1IIZoMtUdIBx9jwEHtghkhHBSjarZSbdXsmJodU7OV6q-Vap9Ln570p9WI_V3hybsMPD8BEPOKhzBvN95xktG2kiJzr4_cjbF4-O8G1NuPV_ON_wGyocBw</recordid><startdate>200510</startdate><enddate>200510</enddate><creator>Vardakas, Konstantinos Z.</creator><creator>Michalopoulos, Argyris</creator><creator>Falagas, Matthew E.</creator><general>Blackwell Science Ltd</general><general>Blackwell</general><general>Blackwell Publishing Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>200510</creationdate><title>Fluconazole versus itraconazole for antifungal prophylaxis in neutropenic patients with haematological malignancies: a meta‐analysis of randomised‐controlled trials</title><author>Vardakas, Konstantinos Z. ; Michalopoulos, Argyris ; Falagas, Matthew E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4747-fb296d1c9a8ae0924bd9e482fcd4610a1b1cc105a238633735113fea6d3749e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>amphotericin B</topic><topic>Antifungal Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Chi-Square Distribution</topic><topic>clotrimazole</topic><topic>Fluconazole - therapeutic use</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hematologic Neoplasms - microbiology</topic><topic>Hematology</topic><topic>Hematopoietic Stem Cell Transplantation</topic><topic>Humans</topic><topic>Immunocompromised Host</topic><topic>Itraconazole - therapeutic use</topic><topic>ketoconazole</topic><topic>Medical sciences</topic><topic>miconazole</topic><topic>Mycoses - complications</topic><topic>Mycoses - prevention & control</topic><topic>Neutropenia</topic><topic>Opportunistic Infections - microbiology</topic><topic>Opportunistic Infections - prevention & control</topic><topic>Other diseases. Hematologic involvement in other diseases</topic><topic>prevention</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vardakas, Konstantinos Z.</creatorcontrib><creatorcontrib>Michalopoulos, Argyris</creatorcontrib><creatorcontrib>Falagas, Matthew E.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of haematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vardakas, Konstantinos Z.</au><au>Michalopoulos, Argyris</au><au>Falagas, Matthew E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fluconazole versus itraconazole for antifungal prophylaxis in neutropenic patients with haematological malignancies: a meta‐analysis of randomised‐controlled trials</atitle><jtitle>British journal of haematology</jtitle><addtitle>Br J Haematol</addtitle><date>2005-10</date><risdate>2005</risdate><volume>131</volume><issue>1</issue><spage>22</spage><epage>28</epage><pages>22-28</pages><issn>0007-1048</issn><eissn>1365-2141</eissn><coden>BJHEAL</coden><abstract>Summary
Fluconazole and itraconazole are used as antifungal prophylaxis in neutropenic patients with haematological malignancies. A meta‐analysis of randomised‐controlled trials (RCTs) was performed in order to compare their safety and effectiveness in this population. Data were obtained from PubMed, Current Contents, Cochrane Central Register for Controlled Trials and references from relevant articles. Five RCTs were included in the analysis. Publication bias and statistically significant heterogeneity was not observed among the analysed studies. Fewer patients were withdrawn due to the development of adverse effects associated with fluconazole when compared with itraconazole [odds ratio (OR) = 0·27, 95% confidence interval (CI): 0·18–0·41]. On the contrary, prophylactic use of fluconazole resulted in significantly more fungal infections (documented and suspected infections combined, OR = 1·62, 95% CI: 1·06–2·48). There were no statistically significant differences regarding documented fungal infections (OR = 1·51, 95% CI: 0·97–2·35), invasive fungal infections (OR = 1·44, 95% CI: 0·96–2·17), overall mortality (OR = 0·89, 95% CI: 0·63–1·24) and mortality attributed by the authors to fungal infections (OR = 1·30, 95% CI: 0·75–2·25) between the two medications. These data suggest that, even though itraconazole is more effective than fluconazole in the prevention of fungal infections in neutropenic patients with haematological malignancies, the development of more adverse effects may limit its use.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>16173959</pmid><doi>10.1111/j.1365-2141.2005.05727.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | amphotericin B Antifungal Agents - therapeutic use Biological and medical sciences Chi-Square Distribution clotrimazole Fluconazole - therapeutic use Hematologic and hematopoietic diseases Hematologic Neoplasms - microbiology Hematology Hematopoietic Stem Cell Transplantation Humans Immunocompromised Host Itraconazole - therapeutic use ketoconazole Medical sciences miconazole Mycoses - complications Mycoses - prevention & control Neutropenia Opportunistic Infections - microbiology Opportunistic Infections - prevention & control Other diseases. Hematologic involvement in other diseases prevention Randomized Controlled Trials as Topic Survival Analysis |
| title | Fluconazole versus itraconazole for antifungal prophylaxis in neutropenic patients with haematological malignancies: a meta‐analysis of randomised‐controlled trials |
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