Posaconazole For Prophylaxis Of Invasive Fungal Infections In Adolescents And Adults: A Meta-analysis

Objective：The aim of this Meta analysis was to assess the efficacy and safety ofposaconazole for prophylaxis of invasive fungal infections in adolescents and adultscompared with some other drugs(amphotericin B lipid complex、fluconazole、itraconazole).So as to provide evidence for clinical decision.Method：We searched the PUBMED、Medline、Embase、Cochrane Library、SinoMed、CNKI、VIP for randomized controlled trials published about posaconazole for prophylaxisof invasive fungal infections in adolescents and adults．The computer search wassupplemented with hand searches of reference lists for available primarystudies． Languages must be English or Chinese,the cut-off time of publication is March2014.Two reviewers independently assessed the quality of the included studies andextracted the data.The Stata12.0software was used.Results:4RCTs which included1476patients met the search criteria were assessed.Meta analysis results: the posaconazole group significantly reduce:the IFI rate[RR=0.414，95％CI(0.273，0.628)，P=0.000＜0.05], especially in prophylaxis for invasive aspergillosis（posaconazole vs fluconazole,P=0.000＜0.05）; number of patients received empiricalantifungal therapy after prophylaxis [RR=0.607，95％CI(0.476，0.775)，P=0.000＜0.05];and mortality from IFI [RR=0.317，95％CI(0.151，0.666)，P=0.002＜0.05].Nosignificant difference was observed in adverse reactions,therapy discontinued because ofadverse reactions, all-cause mortality rate between posaconazole and controlled group（P ＞0.05）.For subgroup analysis,there was no significant difference in both the rate ofadverse reactions and invasive candidiasis infection between posaconazole andfluconazole（P＞0.05）.Conclusion: In terms of currently available RCTs，posaconazole can be considered as agood alternative of amphotericin B lipid complex、fluconazole or itraconazole forprophylaxis of invasive fungal infections in adolescents and adults. Posaconazolesignificantly improves the effect of prophylaxis and decreases IFI associated mortality butwith no risk of increase in adverse events.The value of posaconazole should be evaluatedfurther with the widespread clinical use.