1. CONCLUSIONS INTRODUCTION METHODS
Efficacy and safety of voriconazole in immunocompromised patients: Systematic Review and Metaanalysis
Rosanova MT1 , Bes D 2; Serrano Aguilar P ³ Cuellar Pompa L3 , Sberna N4, Berberian G¹, and Lede R5
1Servicio de Control Epidemiológico e Infectología y 2 Departamento de Pediatría, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina; 3Servicio Canario de Salud. Tenerife. España; 4 Servicio de Farmacia Hospital de Pediatría Juan P. Garrahan. Buenos Aires. Argentina; 5Universidad Abierta Interamericana
INTRODUCTION
Invasive fungal infections (IFI) are among the most important complications in immunocompromised hematology-oncology patients and cause considerable morbidity and mortality. Voriconazole emerges as an alternative for prophylaxis and treatment in IFI in immunocompromised patients.
PURPOSE: To review the efficacy and safety of voriconazole compared with other antifungal drugs or placebo for prevention and/or treatment of IFI
METHODS
The aim of the initial search strategy was to identify randomized controlled studies of acceptable methodological quality (Jadad scale ≥3), through the key word “voriconazole”.
Procedures: A bibliographic search was done combining the endpoint “randomized controlled studies” with the key word “voriconazole”. The search was carried out over the following databases: Medline from 1966 to June 2016.
Forest Plot: Efficacy of voriconazole Pooled Relative Risk (Der Simmonian-Laird): 1.17 (95%CI );
p 0.03 Heterogeneity test: Q 32.7; p
RESULTS
Only 7 publications met the inclusion criteria. Pooled main results showed that voriconazole is more effective than its comparator (RR 1.17; 95%CI 1.01 – 1.34), but heterogeneity was significant (Q test 32.7; p ).
Subanalysis according to the prescribed purpose - prophylaxis or treatment - showed that when voriconazole was indicated as prophylaxis (Mandhaniya et al, Marks et al, Wingard et al, Vehreschild et al, Mattiuzzi et al), RR was 1.17; 95%CI , while when it was indicated as treatment (Walsh et al, Herbrecht et al), RR was 1.23; 95%CI
Risk of overall severe adverse events was not different from that observed using the comparator (RR 1.06, 95%CI ) although significant heterogeneity was detected (p<0.01).
CONCLUSIONS
Voriconazole seems to be as effective and safe as comparators and probably better as prophylaxis than as a treatment agent. However; limitations due to the sample size of the studies, differences in the age of the patients, and heterogeneity among studies and outcome measures point to the need for further research to corroborate our findings.