Logo do repositório
 
Publicação

Comparative efficacy and safety of systemic antifungal agents for candidemia: a systematic review with network meta-analysis and multicriteria acceptability analyses

2022-08Artigo científico Acesso aberto
Ver registo simples
dc.contributor.authorDomingos, Eric L.
dc.contributor.authorVilhena, Raquel O.
dc.contributor.authorSantos, Josiane M.
dc.contributor.authorFachi, Mariana M.
dc.contributor.authorBöger, Beatriz
dc.contributor.authorAdam, Livia M.
dc.contributor.authorTonin, Fernanda
dc.contributor.authorPontarolo, Roberto
dc.date.accessioned2022-06-20T14:50:08Z
dc.date.available2022-06-20T14:50:08Z
dc.date.issued2022-08
dc.description.abstractAim: Invasive candidiasis is the main fungal infection in patients attending health services and is associated with high mortality rates and prolonged hospital stay. We aimed to comparatively evaluate the efficacy and safety of antifungal agents for treating candidemia. Methods: A systematic review with network meta-analysis (NMA), the surface under the cumulative ranking analysis (SUCRA), and stochastic multicriteria acceptability analyses (SMAA) were performed (PROSPERO-CRD42020149264). Searches were conducted in PubMed and Scopus (Nov-2021). Randomised controlled trials evaluating the effect of oral antifungals (any dose or regimen) on mycological cure, discontinuation rates, and adverse events were included. Results: Overall, 13 trials (n=3,632) were analysed. No significant differences among therapies were found for the efficacy outcomes; however, caspofungin (50-150 mg), rezafungin (200-400mg), and micafungin (100-150 mg) were considered the most promising therapies, leading to higher rates of both clinical and mycological responses (SUCRA overall response over 60%). Fluconazole (400 mg) was rated as the last option for overall response (17%). Rezafungin (200-400mg) and micafungin (100 mg) were associated with lower discontinuation rates (<40%); conventional amphotericin B (0.6-0.7mg/kg) was more likely to be discontinued (OR 0.08 [95% CrI 0.00-0.95] vs. caspofungin 150 mg) and may impair liver function (87%). Conclusion: Echinocandins should be listed as first-line treatments for invasive candidiasis following a priority order of caspofungin and micafungin. Rezafungin, an under-development echinocandin, represents a potential option that should be further investigated. Azoles and liposomal amphotericin B can be used as second-line treatments in cases of fungal resistance or hypersensitivity.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationDomingos EL, Vilhena RO, Santos JM, Fachi MM, Böger B, Adam LM, Tonin FS, et al. Comparative efficacy and safety of systemic antifungal agents for candidemia: a systematic review with network meta-analysis and multicriteria acceptability analyses. Int J Antimicrob Agents. 2022;60(2):106614.pt_PT
dc.identifier.doi10.1016/j.ijantimicag.2022.106614pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.21/14716
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttps://www.sciencedirect.com/science/article/pii/S0924857922001261pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/pt_PT
dc.subjectAntifungal agentspt_PT
dc.subjectInvasive candidiasispt_PT
dc.subjectInvasive fungal infectionpt_PT
dc.subjectMeta-analysispt_PT
dc.subjectSystematic reviewpt_PT
dc.titleComparative efficacy and safety of systemic antifungal agents for candidemia: a systematic review with network meta-analysis and multicriteria acceptability analysespt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue2pt_PT
oaire.citation.startPage106614pt_PT
oaire.citation.titleInternational Journal of Antimicrobial Agentspt_PT
oaire.citation.volume60pt_PT
person.familyNameTonin
person.givenNameFernanda
person.identifier.ciencia-idD01C-C700-9411
person.identifier.orcid0000-0003-4262-8608
person.identifier.ridO-2050-2017
person.identifier.scopus-author-id56085115800
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication61ded30e-ecec-4b3e-b953-2293e080ebdd
relation.isAuthorOfPublication.latestForDiscovery61ded30e-ecec-4b3e-b953-2293e080ebdd

Ficheiros

Principais
A mostrar 1 - 1 de 1
Miniatura indisponível
Nome:
Comparative efficacy and safety of systemic antifungal agents for candidemia_a systematic review with network meta-analysis and multicriteria acceptability analyses.pdf
Tamanho:
842.75 KB
Formato:
Adobe Portable Document Format
Ver/Abrir

Coleções

ESTeSL - Artigos