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SYSTEMATIC REVIEW article

Front. Microbiol.
Sec. Infectious Agents and Disease
Volume 15 - 2024 | doi: 10.3389/fmicb.2024.1504826

Comparison of Antifungal Drugs in the Treatment of Invasive Pulmonary Aspergillosis: A Systematic Review and Network Metaanalysis

Provisionally accepted
Jing Cheng Jing Cheng 1,2Hedong Han Hedong Han 1Wenwen Kang Wenwen Kang 1Zijin Cai Zijin Cai 2*PING ZHAN PING ZHAN 1Tangfeng Lv Tangfeng Lv 1*
  • 1 Nanjing University, Nanjing, China
  • 2 Nanjing Medical University, Nanjing, Jiangsu Province, China

The final, formatted version of the article will be published soon.

    Background: Voriconazole, isavuconazole, and amphotericin (AmB) formulations are currently recommended to treat invasive pulmonary aspergillosis (IPA). We aimed to estimate the efficacy of different antifungal drugs in the initial treatment of IPA.We included all available randomized controlled trials (RCTs) evaluating first-line treatments for IPA by searching PubMed, Medline, EMBASE, the Cochrane Library, and the ClinicalTrials.gov database. We performed a network meta-analysis to compare the relative efficacy of different drugs in treating IPA. The primary outcomes were the overall response and all-cause mortality (ACM).Results: Eight studies were identified that compared different drugs including voriconazole, isavuconazole, posaconazole, anidulafungin, liposomal AmB (L-AmB) at standard, high and low doses (3-5mg/kg/d; 10mg/kg/d; 1mg/kg/d), AmB deoxycholate (dAmB) and amphotericin B colloidal dispersion (ABCD). We found that second-generation triazole antifungal drugs containing voriconazole, isavuconazole, and posaconazole exhibited significantly superior overall response to dAmB and ABCD. Voriconazole was ranked as the best drug on network rank analysis. We found no difference in efficacy between triazole antifungals and L-AmB. A combination of voriconazole with anidulafungin, isavuconazole and voriconazole showed significantly better safety than dAmB.The efficacy of second-generation triazole antifungal drugs for the first-line treatment of IPA is comparable with L-AmB and is better than both dAmB and ABCD. Isavuconazole may show better safety than voriconazole and posaconazole. Combination therapy with voriconazole and anidulafungin may serve as an alternative option for IPA patients with limited drug tolerance.

    Keywords: Invasive Pulmonary Aspergillosis, Voriconazole, Isavuconazole, Posaconazole, Amphotericin B

    Received: 01 Oct 2024; Accepted: 18 Nov 2024.

    Copyright: © 2024 Cheng, Han, Kang, Cai, ZHAN and Lv. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Zijin Cai, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
    Tangfeng Lv, Nanjing University, Nanjing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.