Meta-analysis of the safety of voriconazole in definitive, empirical, and prophylactic therapies for invasive fungal infections
Abstract Background Voriconazole has been used in the treatment and prophylaxis of invasive fungal infections (IFIs) while its wide use was limited by some frequent adverse events, especially neurotoxicity, hepatotoxicity and even renal disruption. The aim of this study was to comprehensively compar...
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-017-2913-8 |
| _version_ | 1818148602748338176 |
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| author | Yuanming Xing Lu Chen Yan Feng Yan Zhou Yajing Zhai Jun Lu |
| author_facet | Yuanming Xing Lu Chen Yan Feng Yan Zhou Yajing Zhai Jun Lu |
| author_sort | Yuanming Xing |
| collection | DOAJ |
| description | Abstract Background Voriconazole has been used in the treatment and prophylaxis of invasive fungal infections (IFIs) while its wide use was limited by some frequent adverse events, especially neurotoxicity, hepatotoxicity and even renal disruption. The aim of this study was to comprehensively compare voriconazole-induced toxicity, including tolerability, neurotoxicity, visual toxicity, hepatotoxicity and nephrotoxicity with the composite of other antifungals commonly used in clinic. Methods Bibliography databases were searched to select randomized controlled trials providing information about the incidence of toxicity referred above. A total of 4122 patients from 16 studies were included in the meta-analysis. Results Analysis of individual types of toxicity showed that there was a significant difference between voriconazole and the composite of other antifungal agents. The primary outcome, the tolerability of voriconazole was slightly inferior (OR = 1.71, 95% CI = 1.21–2.40, P = 0.002) and it is noteworthy that the probabilities of neurotoxicity and visual toxicity were around twice higher and six-fold for voriconazole compared with the counterpart (OR = 1.99, 95% CI = 1.05–3.75, P = 0.03 and OR = 6.50, 95% CI = 2.93–14.41, P < 0.00001, respectively). Hepatotoxicity was more common in voriconazole group (OR = 1.60, 95% CI = 1.17–2.19, P = 0.003) whereas its pooled risk of nephrotoxicity was about half of the composite of other five antifungal agents (OR = 0.46, 95% CI = 0.26–0.84, P = 0.01). Conclusion Our analysis has revealed differences in multiple types of toxicity induced by VRC versus other antifungals and quantified the corresponding pooled risks, which could provide an alternative for patients with a certain antifungal intolerance and help the clinician to select the optimal intervention. |
| first_indexed | 2024-12-11T12:53:45Z |
| format | Article |
| id | doaj.art-9c9d94b1240b4c7084ca50e7ea0fa6a2 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-11T12:53:45Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-9c9d94b1240b4c7084ca50e7ea0fa6a22022-12-22T01:06:38ZengBMCBMC Infectious Diseases1471-23342017-12-0117111210.1186/s12879-017-2913-8Meta-analysis of the safety of voriconazole in definitive, empirical, and prophylactic therapies for invasive fungal infectionsYuanming Xing0Lu Chen1Yan Feng2Yan Zhou3Yajing Zhai4Jun Lu5Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong UniversityClinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong UniversityClinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong UniversityClinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong UniversityClinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong UniversityAbstract Background Voriconazole has been used in the treatment and prophylaxis of invasive fungal infections (IFIs) while its wide use was limited by some frequent adverse events, especially neurotoxicity, hepatotoxicity and even renal disruption. The aim of this study was to comprehensively compare voriconazole-induced toxicity, including tolerability, neurotoxicity, visual toxicity, hepatotoxicity and nephrotoxicity with the composite of other antifungals commonly used in clinic. Methods Bibliography databases were searched to select randomized controlled trials providing information about the incidence of toxicity referred above. A total of 4122 patients from 16 studies were included in the meta-analysis. Results Analysis of individual types of toxicity showed that there was a significant difference between voriconazole and the composite of other antifungal agents. The primary outcome, the tolerability of voriconazole was slightly inferior (OR = 1.71, 95% CI = 1.21–2.40, P = 0.002) and it is noteworthy that the probabilities of neurotoxicity and visual toxicity were around twice higher and six-fold for voriconazole compared with the counterpart (OR = 1.99, 95% CI = 1.05–3.75, P = 0.03 and OR = 6.50, 95% CI = 2.93–14.41, P < 0.00001, respectively). Hepatotoxicity was more common in voriconazole group (OR = 1.60, 95% CI = 1.17–2.19, P = 0.003) whereas its pooled risk of nephrotoxicity was about half of the composite of other five antifungal agents (OR = 0.46, 95% CI = 0.26–0.84, P = 0.01). Conclusion Our analysis has revealed differences in multiple types of toxicity induced by VRC versus other antifungals and quantified the corresponding pooled risks, which could provide an alternative for patients with a certain antifungal intolerance and help the clinician to select the optimal intervention.http://link.springer.com/article/10.1186/s12879-017-2913-8VoriconazoleInvasive fungal infectionsTolerabilityMeta-analysis |
| spellingShingle | Yuanming Xing Lu Chen Yan Feng Yan Zhou Yajing Zhai Jun Lu Meta-analysis of the safety of voriconazole in definitive, empirical, and prophylactic therapies for invasive fungal infections BMC Infectious Diseases Voriconazole Invasive fungal infections Tolerability Meta-analysis |
| title | Meta-analysis of the safety of voriconazole in definitive, empirical, and prophylactic therapies for invasive fungal infections |
| title_full | Meta-analysis of the safety of voriconazole in definitive, empirical, and prophylactic therapies for invasive fungal infections |
| title_fullStr | Meta-analysis of the safety of voriconazole in definitive, empirical, and prophylactic therapies for invasive fungal infections |
| title_full_unstemmed | Meta-analysis of the safety of voriconazole in definitive, empirical, and prophylactic therapies for invasive fungal infections |
| title_short | Meta-analysis of the safety of voriconazole in definitive, empirical, and prophylactic therapies for invasive fungal infections |
| title_sort | meta analysis of the safety of voriconazole in definitive empirical and prophylactic therapies for invasive fungal infections |
| topic | Voriconazole Invasive fungal infections Tolerability Meta-analysis |
| url | http://link.springer.com/article/10.1186/s12879-017-2913-8 |
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