Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis
Objective: A meta-analysis was performed to compare mold-active triazoles or lipid amphotericin B plus an echinocandin to non-echinocandin monotherapy for acute invasive aspergillosis (IA). Methods: We searched PubMed, EMBASE, and other databases through May 2013 unrestricted by language. We include...
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| Format: | Article |
| Language: | English |
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Elsevier
2014-11-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971214015926 |
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| author | Anil A. Panackal Emilio Parisini Michael Proschan |
| author_facet | Anil A. Panackal Emilio Parisini Michael Proschan |
| author_sort | Anil A. Panackal |
| collection | DOAJ |
| description | Objective: A meta-analysis was performed to compare mold-active triazoles or lipid amphotericin B plus an echinocandin to non-echinocandin monotherapy for acute invasive aspergillosis (IA).
Methods: We searched PubMed, EMBASE, and other databases through May 2013 unrestricted by language. We included observational and experimental studies wherein patients with proven or probable IA by EORTC/MSG criteria underwent our comparative intervention. PRISMA and MOOSE guidelines were followed and quality was assessed using the Jadad and Newcastle–Ottawa criteria. Meta-regression with fixed and random effects and sensitivity analyses were performed. The primary study outcome measure was 12-week overall mortality. The secondary outcome assessed was complete and partial response.
Results: Only observational studies of primary 12-week survival showed heterogeneity (I2 = 48.96%, p = 0.05). For salvage IA therapy, fixed effects models demonstrated improved 12-week survival (Peto odds ratio (OR) 1.80, 95% confidence interval (CI) 1.08–3.01) and success (Peto OR 2.17, 95% CI 1.21–3.91) of combination therapy. Significance remained after applying random effects as a sensitivity analysis (12-week survival: Peto OR 1.90, 95% CI 1.04–3.46, and unchanged value for success). Restriction to high quality studies and including echinocandins as the comparator for refractory IA revealed an adjusted OR of 1.72 (95% CI 0.96–3.09; p = 0.07) for global success, while the survival endpoint remained unaltered.
Conclusions: Combination antifungals for IA demonstrate improved outcomes over monotherapy in the salvage setting. Clinicians should consider this approach in certain situations. |
| first_indexed | 2024-12-21T05:25:29Z |
| format | Article |
| id | doaj.art-d832d07273db4b1caf12554c243c3ebd |
| institution | Directory Open Access Journal |
| issn | 1201-9712 1878-3511 |
| language | English |
| last_indexed | 2024-12-21T05:25:29Z |
| publishDate | 2014-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-d832d07273db4b1caf12554c243c3ebd2022-12-21T19:14:42ZengElsevierInternational Journal of Infectious Diseases1201-97121878-35112014-11-0128C809410.1016/j.ijid.2014.07.007Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysisAnil A. Panackal0Emilio Parisini1Michael Proschan2Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Clinical Research Center, Building 10, Room 11N222, 10 Center Drive, Bethesda, MD 20892, MSC 1888, USACenter for Nano Science and Technology, Politecnico di Milano, Istituto Italiano di Tecnologia, Milan, ItalyBiostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USAObjective: A meta-analysis was performed to compare mold-active triazoles or lipid amphotericin B plus an echinocandin to non-echinocandin monotherapy for acute invasive aspergillosis (IA). Methods: We searched PubMed, EMBASE, and other databases through May 2013 unrestricted by language. We included observational and experimental studies wherein patients with proven or probable IA by EORTC/MSG criteria underwent our comparative intervention. PRISMA and MOOSE guidelines were followed and quality was assessed using the Jadad and Newcastle–Ottawa criteria. Meta-regression with fixed and random effects and sensitivity analyses were performed. The primary study outcome measure was 12-week overall mortality. The secondary outcome assessed was complete and partial response. Results: Only observational studies of primary 12-week survival showed heterogeneity (I2 = 48.96%, p = 0.05). For salvage IA therapy, fixed effects models demonstrated improved 12-week survival (Peto odds ratio (OR) 1.80, 95% confidence interval (CI) 1.08–3.01) and success (Peto OR 2.17, 95% CI 1.21–3.91) of combination therapy. Significance remained after applying random effects as a sensitivity analysis (12-week survival: Peto OR 1.90, 95% CI 1.04–3.46, and unchanged value for success). Restriction to high quality studies and including echinocandins as the comparator for refractory IA revealed an adjusted OR of 1.72 (95% CI 0.96–3.09; p = 0.07) for global success, while the survival endpoint remained unaltered. Conclusions: Combination antifungals for IA demonstrate improved outcomes over monotherapy in the salvage setting. Clinicians should consider this approach in certain situations.http://www.sciencedirect.com/science/article/pii/S1201971214015926Invasive aspergillosisCombination antifungal therapyOutcomesSalvage therapy |
| spellingShingle | Anil A. Panackal Emilio Parisini Michael Proschan Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis International Journal of Infectious Diseases Invasive aspergillosis Combination antifungal therapy Outcomes Salvage therapy |
| title | Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis |
| title_full | Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis |
| title_fullStr | Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis |
| title_full_unstemmed | Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis |
| title_short | Salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes: a systematic review and meta-analysis |
| title_sort | salvage combination antifungal therapy for acute invasive aspergillosis may improve outcomes a systematic review and meta analysis |
| topic | Invasive aspergillosis Combination antifungal therapy Outcomes Salvage therapy |
| url | http://www.sciencedirect.com/science/article/pii/S1201971214015926 |
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