Bow, E.J., Vanness, D.J., Slavin, M., Cordonnier, C., Cornely, O.A., Marks, D.I., . . . Schlamm, H. (2015). Systematic review and mixed treatment comparison meta-analysis of randomized clinical trials of primary oral antifungal prophylaxis in allogeneic hematopoietic cell transplant recipients. BMC Infectious Diseases, 15, 128-015-0855-6.

STUDY PURPOSE: To compare clinical trials examining outcomes with use of oral antifungal agents for prophylaxis in patients undergoing hematopoietic cell transplantation

• FINAL NUMBER STUDIES INCLUDED = 5
• TOTAL PATIENTS INCLUDED IN REVIEW = 2,147
• SAMPLE RANGE ACROSS STUDIES: 140–600 patients
• KEY SAMPLE CHARACTERISTICS: Not provided.

PHASE OF CARE: Transition phase after active treatment

Network meta-analysis using Bayesian statistical techniques were used. Results showed that voriconazole was the agent most likely to reduce incidence of overall probable or proven invasive fungal infection at 180 days post-transplantation. Mold-active agents voriconazole, itraconazole, and posaconazole were overall more likely to be effective than fluconazole as primary antifungal prophylaxis.

Findings suggest that primary antifungal prophylaxis with mold-active agents are more effective for patients undergoing allogeneic HCT.

• Few studies included

Primary antifungal prophylaxis with mold-active agents may be preferred to reduce probable or proven invasive fungal infections. Aspergillus tends to predominate invasive fungal infections in this group of patients. There is limited data directly comparing the various mold-active agents.