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Efficacy and safety of micafungin versus extensive azoles in the prevention and treatment of invasive fungal infections for neutropenia patients with hematological malignancies: A meta-analysis of randomized controlled trials

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  • Cho-Hao Lee
  • Jung-Chung Lin
  • Ching-Liang Ho
  • Min Sun
  • Wel-Ting Yen
  • Chin Lin

Abstract

Background: Current studies that compare the efficacy and safety of micafungin (MCFG) with that of triazoles for the prophylaxis and treatment of invasive fungal infections (IFIs) demonstrate a lack of sufficient evidence and yield conflicting results. To compare the efficacy and safety of MCFG and triazoles in the prevention and treatment of IFIs, we conducted a meta-analysis and trial sequential analysis (TSA). Methods: For the meta-analysis, we systematically searched the databases of PubMed, Embase and Cochrane Central Register of Controlled Trials and relevant database articles for randomized controlled studies published through November 2016. Comparative studies of the efficacy and safety of MCFG versus triazoles in the prevention and treatment of IFIs were selected. Meta-analysis was performed by R software with the “metafor” package. Pooled results were expressed as risk ratios (RRs) with corresponding 95% confidence intervals (CI). TSA was adopted to assess the studies’ power with TSA version 0.9 beta. Results: Nine current studies were included in the meta-analysis (1049 cases and 959 controls). Pooled trial comparisons indicated that MCFG does have significantly higher treatment success rates (RR = 1.13; 95% CI, 1.02–1.25; p = 0.0205) and reduces the number of overall IFIs (RR = 0.75; 95% CI, 0.61–0.92; p = 0.0056). However, MCFG demonstrates no difference in all-cause mortality (RR = 0.76; 95% CI, 0.52–1.12, p = 0.1624). For the safety evaluation, MCFG had a significantly lower incidence of severe adverse events (AEs) (RR = 0.45; 95% CI, 0.25–0.83; p = 0.0105), hepatic impairment (RR = 0.70; 95% CI, 0.50–0.97; p = 0.0363) and premature discontinuation (RR = 0.51; 95% CI, 0.34–0.76, p = 0.0010). Meta-regression analysis disclosed the correction of mean age and treatment success rates (P

Suggested Citation

  • Cho-Hao Lee & Jung-Chung Lin & Ching-Liang Ho & Min Sun & Wel-Ting Yen & Chin Lin, 2017. "Efficacy and safety of micafungin versus extensive azoles in the prevention and treatment of invasive fungal infections for neutropenia patients with hematological malignancies: A meta-analysis of ran," PLOS ONE, Public Library of Science, vol. 12(7), pages 1-20, July.
    • Handle: RePEc:plo:pone00:0180050
    DOI: 10.1371/journal.pone.0180050
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    References listed on IDEAS

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    1. Kristian Thorlund & Georgina Imberger & Michael Walsh & Rong Chu & Christian Gluud & Jørn Wetterslev & Gordon Guyatt & Philip J Devereaux & Lehana Thabane, 2011. "The Number of Patients and Events Required to Limit the Risk of Overestimation of Intervention Effects in Meta-Analysis—A Simulation Study," PLOS ONE, Public Library of Science, vol. 6(10), pages 1-10, October.
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