The efficacy and safety of first-line monotherapies in primary therapy of invasive aspergillosis: a systematic review
ObjectiveSeveral antifungals are available for the treatment of patients with invasive aspergillosis (IA). This study aims to evaluate the relative efficacy and safety of the first-line monotherapies in primary therapy of IA through network meta-analysis (NMA).MethodsWe systematically searched PubMe...
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Frontiers Media S.A.
2025-01-01
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| author | Yan Chen Yan Chen Jiaojiao Zhao Jiaojiao Zhao Yifei Wang Yifei Wang Long Ge Long Ge Joey Sum-wing Kwong Junjie Lan Rui Zhang Huaye Zhao Linfang Hu Jiaxue Wang Shuimei Sun Songsong Tan Xiaoqing Lin Rui He Wenyi Zheng Xiaosi Li Jiaxing Zhang |
| author_facet | Yan Chen Yan Chen Jiaojiao Zhao Jiaojiao Zhao Yifei Wang Yifei Wang Long Ge Long Ge Joey Sum-wing Kwong Junjie Lan Rui Zhang Huaye Zhao Linfang Hu Jiaxue Wang Shuimei Sun Songsong Tan Xiaoqing Lin Rui He Wenyi Zheng Xiaosi Li Jiaxing Zhang |
| author_sort | Yan Chen |
| collection | DOAJ |
| description | ObjectiveSeveral antifungals are available for the treatment of patients with invasive aspergillosis (IA). This study aims to evaluate the relative efficacy and safety of the first-line monotherapies in primary therapy of IA through network meta-analysis (NMA).MethodsWe systematically searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP database, Wanfang database, and China Biology Medicine for randomized controlled trials (RCTs) up to July 2023 that evaluated the efficacy and safety of monotherapies. We performed NMA with a frequentist random effects model and assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Primary outcomes were the all-cause mortality at week 12, and secondary outcomes included overall response rate, and incidence of adverse events (AEs) and severe adverse events (SAEs).ResultsA total of three RCTs involving 1,368 participants (four antifungals) were included. The NMA showed that compared to amphotericin B deoxycholate (D-AmB), the triazoles (posaconazole (POS), isavuconazole (ISA) and voriconazole (VCZ)) can improve the overall response rate in primary therapy of IA, but only VCZ and ISA can reduce the all-cause mortality at week 12 for patients with proven and probable IA (VCZ vs D-AmB: RR = 0.66, 95%CI = 0.47–0.93, moderate certainty; ISA vs D-AmB: RR = 0.52, 95%CI = 0 .31–0.86, low certainty). ISA (SUCRA = 93.50%; mean rank, 1.20) seemed to be the most effective therapy in the above population. As to proven, probable, and possible IA patients, the triazoles were superior to D-AmB in terms of reducing all-cause mortality. Furthermore, the risk of AEs and SAEs was comparable for the three triazoles, but the risk of SAEs was significantly higher for D-AmB than others.ConclusionThe efficacy and safety of triazoles are more favorable than D-AmB in the primary therapy of IA, with ISA being the optimal choice.Systematic Review RegistrationPROSPERO CRD42023407632. |
| format | Article |
| id | doaj-art-ee2817e653ce49609e5d8fed3694e128 |
| institution | Kabale University |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-01-01 |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-ee2817e653ce49609e5d8fed3694e1282025-01-15T07:44:59ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-01-011510.3389/fphar.2024.15309991530999The efficacy and safety of first-line monotherapies in primary therapy of invasive aspergillosis: a systematic reviewYan Chen0Yan Chen1Jiaojiao Zhao2Jiaojiao Zhao3Yifei Wang4Yifei Wang5Long Ge6Long Ge7Joey Sum-wing Kwong8Junjie Lan9Rui Zhang10Huaye Zhao11Linfang Hu12Jiaxue Wang13Shuimei Sun14Songsong Tan15Xiaoqing Lin16Rui He17Wenyi Zheng18Xiaosi Li19Jiaxing Zhang20School of Pharmaceutical Sciences, Guizhou University, Guiyang, ChinaDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaSchool of Pharmaceutical Sciences, Guizhou University, Guiyang, ChinaDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaSchool of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, ChinaDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaEvidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, ChinaDepartment of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, ChinaGlobal Health Nursing, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, JapanDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaOffice of Health Insurance Administration, Guizhou Provincial People’s Hospital, Guiyang, ChinaSchool of Public Health, The key Laboratory of Environmental Pollution Monitoringand Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, ChinaExperimental Cancer Medicine, Department of Laboratory Medicine, Karolinska Institute, Stockholm, SwedenExperimental Cancer Medicine, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden0Department of Pharmacy, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, ChinaDepartment of Pharmacy, Guizhou Provincial People’s Hospital, Guiyang, ChinaObjectiveSeveral antifungals are available for the treatment of patients with invasive aspergillosis (IA). This study aims to evaluate the relative efficacy and safety of the first-line monotherapies in primary therapy of IA through network meta-analysis (NMA).MethodsWe systematically searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP database, Wanfang database, and China Biology Medicine for randomized controlled trials (RCTs) up to July 2023 that evaluated the efficacy and safety of monotherapies. We performed NMA with a frequentist random effects model and assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Primary outcomes were the all-cause mortality at week 12, and secondary outcomes included overall response rate, and incidence of adverse events (AEs) and severe adverse events (SAEs).ResultsA total of three RCTs involving 1,368 participants (four antifungals) were included. The NMA showed that compared to amphotericin B deoxycholate (D-AmB), the triazoles (posaconazole (POS), isavuconazole (ISA) and voriconazole (VCZ)) can improve the overall response rate in primary therapy of IA, but only VCZ and ISA can reduce the all-cause mortality at week 12 for patients with proven and probable IA (VCZ vs D-AmB: RR = 0.66, 95%CI = 0.47–0.93, moderate certainty; ISA vs D-AmB: RR = 0.52, 95%CI = 0 .31–0.86, low certainty). ISA (SUCRA = 93.50%; mean rank, 1.20) seemed to be the most effective therapy in the above population. As to proven, probable, and possible IA patients, the triazoles were superior to D-AmB in terms of reducing all-cause mortality. Furthermore, the risk of AEs and SAEs was comparable for the three triazoles, but the risk of SAEs was significantly higher for D-AmB than others.ConclusionThe efficacy and safety of triazoles are more favorable than D-AmB in the primary therapy of IA, with ISA being the optimal choice.Systematic Review RegistrationPROSPERO CRD42023407632.https://www.frontiersin.org/articles/10.3389/fphar.2024.1530999/fullinvasive aspergillosisantifungalsnetwork meta-analysisaspergillusposaconazoleamphotericin B deoxycholate |
| spellingShingle | Yan Chen Yan Chen Jiaojiao Zhao Jiaojiao Zhao Yifei Wang Yifei Wang Long Ge Long Ge Joey Sum-wing Kwong Junjie Lan Rui Zhang Huaye Zhao Linfang Hu Jiaxue Wang Shuimei Sun Songsong Tan Xiaoqing Lin Rui He Wenyi Zheng Xiaosi Li Jiaxing Zhang The efficacy and safety of first-line monotherapies in primary therapy of invasive aspergillosis: a systematic review Frontiers in Pharmacology invasive aspergillosis antifungals network meta-analysis aspergillus posaconazole amphotericin B deoxycholate |
| title | The efficacy and safety of first-line monotherapies in primary therapy of invasive aspergillosis: a systematic review |
| title_full | The efficacy and safety of first-line monotherapies in primary therapy of invasive aspergillosis: a systematic review |
| title_fullStr | The efficacy and safety of first-line monotherapies in primary therapy of invasive aspergillosis: a systematic review |
| title_full_unstemmed | The efficacy and safety of first-line monotherapies in primary therapy of invasive aspergillosis: a systematic review |
| title_short | The efficacy and safety of first-line monotherapies in primary therapy of invasive aspergillosis: a systematic review |
| title_sort | efficacy and safety of first line monotherapies in primary therapy of invasive aspergillosis a systematic review |
| topic | invasive aspergillosis antifungals network meta-analysis aspergillus posaconazole amphotericin B deoxycholate |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1530999/full |
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