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Antimicrob Agents Chemother:血液系统恶性肿瘤初级真菌预防 13种疗法中脱颖而出的是…

2019-01-18 王淳 环球医学

2018年7月,台湾学者发表在《Antimicrob Agents Chemother》的随机对照试验(RCT)的网络Meta分析,比较了血液系统恶性肿瘤初级真菌预防。

2018年7月,台湾学者发表在《Antimicrob Agents Chemother》的随机对照试验(RCT)的网络Meta分析,比较了血液系统恶性肿瘤初级真菌预防

背景:对于血液系统恶性肿瘤患者中性粒细胞减少症发热的初级真菌预防,目前一些新的抗真菌药物已经变得可及。研究者旨在综合所有有效性的证据,并比较所有的现有疗法。

方法:研究者进行了一项系统的文献评价,旨在鉴别出目前所有随机对照试验的公开证据。研究者检索了Embase、PubMed、Cochrane对照临床试验中心登记、www.ClinicalTrials.gov网站。

结果:总共鉴别了54项RCT,包括13种治疗选择。使用网络Meta分析综合证据。采用了相对风险(RR)。泊沙康唑在初级预防的有效性排名中最高,在以下方面是最有利的:(1)侵袭性真菌感染降低的RR(0.19;95% 置信区间[CI],0.11~0.36);(2)作为最佳选择的概率(累积排名的94%)。泊沙康唑也在预防侵袭性曲霉病和经证实的真菌感染中证实了其有效性,RR分别为0.13(CI,0.03~0.65)和0.14(CI,0.05~0.38)。然而,所有抗真菌药物在全因死亡率和总体不良事件方面无显着差异。

结论:本网络meta分析为进行骨髓抑制化疗或造血细胞移植的血液恶性肿瘤患者的中性粒细胞减少症发热,提供了初级真菌预防全部可及治疗选择的相对有效性的综合评价。基于本分析,在基于现有头对头的RCT情况下,泊沙康唑是最有效的预防选择。

原始出处:

Lee CH, Lin C, Ho CL, et al. Primary Fungal Prophylaxis in Hematological Malignancy: a Network Meta-Analysis of Randomized Controlled Trials. Antimicrob Agents Chemother. 2018 Jul 27;62(8). pii: e00355-18. doi: 10.1128/AAC.00355-18.

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    2019-06-19 wjywjy
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    2019-06-26 xjy02
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    2019-02-26 grace5700
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    2019-01-20 zhaojie88

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