Efficacy and safety of posaconazole in prophylaxis against invasive fungal infections in patients with hematological malignancies: a Meta-analysis

Abstract

Objective To systematically evaluate the efficacy and safety of posaconazole in prophylaxis against invasive fungal infection (IFI) in patirnts with hematological malignancies. Methods From the date of databases inception to October 2018, English databases, such as PubMed, Web of Science database and others, as well as Chinese databases, such as Wanfang Date Knowledge Service Platform, Weipu Chinese Science and Technology Journal Database, China National Knowledge Infrastructure (CNKI) and Chinese Biomedical Literature Database (CBM) and others were searched to identify research literature of the randomized controlled trials (RCT) of posaconazole in prophylaxis of IFI in patients with hematological malignancies with study group receiving posaconazole and control group receiving other anti-fungal drugs. The two researchers independently screened the literatures according to the inclusion and exclusion criteria of the literatures set in this study, and evaluated the quality of the included literatures and extracted the materials. Efficacy and safety of posaconazole for preventing IFI in patients with hematological malignancies were Meta analyzed with Revman 5.3 software. The main outcome evaluation indexes of effectiveness and safety of posaconazole in preventing IFI of patients with hematological malignancies include: effectiveness indicator (IFI incidence rate), safety indicators (adverse reactions incidence rate and all-cause mortality). Results Through literature screening, a total of 6 RCTs met the inclusion criteria in this study. A total of 1 994 patients with hematological malignancies were included, including 1 057 patients in study group and 937 patients in control group. ① Meta-analysis of posaconzole to prevent the incidence of IFI in patients with hematological malignancies showed that, incidence rate of IFI in study group was lower than that of control group, and the difference was statistically significant (OR=0.37, 95%CI: 0.27-0.51, P<0.0001). Incidence rate of IFI in patients treated with posaconazole was lower than that of patients treated with fluconazole and itraconazole, respectively, and the differences were statistically significant (OR=0.41, 95%CI: 0.27-0.63, P<0.0001; OR=0.31, 95%CI: 0.20-0.49, P<0.0001). There were no statistical significant difference in incidence rate of IFI between patients treated with posaconazole and voriconazole (OR=0.13, 95%CI: 0.01-2.67, P=0.19). ② Meta-analysis on the incidence rate of adverse reactions to prevent IFI by posaconazole showed that, incidence rate of adverse reactions in study group was lower than that in control group, and the difference was statistically significant (OR=0.80, 95%CI: 0.64-0.99, P=0.04). ③ Meta-analysis on all-cause mortality of posaconazole patients for prevention of IFI showed that, all-cause mortality in the study group was lower than that in control group, and the difference was statistically significant (OR=0.71, 95%CI: 0.55-0.91, P=0.007). Conclusion Posaconazole is more effective than other antifungal drugs in preventing IFI in patients with hematological malignancies, and has higher safety. Key words: Posaconazole; Fluconazole; Itraconazole; Voriconazole; Invasive fungal infections; Meta-analysis