Treatment of invasive candidiasis in neutropenic patients: systematic review of randomized controlled treatment trials

• Published in: Leukemia & lymphoma 2013-07, Vol.54 (7), p.1479-1487
• Main Authors: Kanji, Jamil N., Laverdière, Michel, Rotstein, Coleman, Walsh, Thomas J., Shah, Prakesh S., Haider, Shariq
• Format: Article
• Language: English
• Subjects: amphotericin B; Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Candidiasis; Candidiasis, Invasive - drug therapy; Candidiasis, Invasive - etiology; Candidiasis, Invasive - mortality; echinocandin; Echinocandins - therapeutic use; Humans; invasive; neutropenia; Neutropenia - complications; Odds Ratio; Randomized Controlled Trials as Topic
• ISSN: 1042-8194; 1029-2403
• DOI: 10.3109/10428194.2012.745073

Abstract Candidemia and invasive candidiasis (CIC) is associated with considerable morbidity and mortality, with a paucity of controlled data in neutropenic patients. A systematic review was conducted of available data for the treatment of CIC during neutropenia. A structured OVID search of multiple databases was performed. Data from randomized controlled trials of CIC and of empirical antifungal therapy in febrile neutropenic patients was included. A total of 17 trials randomizing 342 neutropenic patients were included. Eight of the studies compared amphotericin B (AmB) to other non-polyene antifungal agents. Pooling of results favored use of comparator compounds (odds ratio [OR] 0.73; 95% confidence interval [CI] 0.42-1.29). To strengthen our analysis, a pre-planned sensitivity analysis was also conducted. Overall, there was a non-significant benefit in favor of non-polyene compounds. Across studies, echinocandins provided the benefit of favorable outcomes with fewest side effects and toxicity.