Poredjenje efikasnosti i bezbednosti triazola sa ehinokandinima u lečenju invazivne aspergiloze: meta-analiza
Sažetak
Uvod/Cilj. Iako većina vodiča preporučuje triazole (vorikonazol, itrakonazol, posakonazol i isavukonazol) kao primarnu terapijsku opciju za lečenje invazivne aspergiloze, ehinokandini (kaspofungin, mikafungin i anidulafungin) takođe se koriste u ovu svrhu. Uprkos ovoj činjenici, poređenje triazola i ehinokandina za lečenje invazivne aspergiloze retko je ispitivano u kliničkim studijama. Cilj ove meta-analize bio je da uporedi efikasnost i bezbednost triazola sa ehinokandinima kod bolesnika sa invazivnom aspergilozom. Metode. Ova meta-analiza je bazirana na sistematskoj pretrazi literature i biranju najkvalitetnijih studija prema uključujućim i isključujućim kriterijumima. Literatura je pretraživana za poređenje lečenja bilo kojim od triazola (isavukonazol, itrakonazol, posakonazol ili vorikonazol) naprema lečenju ehinokandinima (kaspofungin, anidulafungin ili mikafungin). Efekti triazola (itrakonazola, posakonazola i vorikonazola) i ehinokandina (kaspofungina, anidulafungina i mikafungin) sumirani su u RevMan 5.3.5 programu, a heterogenost je određena Cochrane Q testom i I² vrednostima. Nekoliko tipova sistematskih grešaka zbog pristrasnoti (bias) je ispitano, a sistematska greška u pogledu pristrasnosti u publikovanju je prikazana pomoću funel plot-a i Eger-ove regresije. Rezultati. Dve kliničke studije i tri kohortne studije bile su uključene u meta-analizu. Smrtnost kod bolesnika sa invazivnom aspergilozom, koji su tretirani triazolima, bila je značajno manja u poređenju sa onom kod bolsnika lečeniuh ehinokandinima [odds ratio 0.29 (0.13, 0.67)], i stopa povoljnog odgovora (uspeh lečenja) nakon 12 nedelja terapije bila je veća kod triazola [3.05 (1.52, 6.13)]. Sa druge strane incidencija neželjenih efekata bila je veća, ali ne statistički značajno, kod triazola nego kod ehinokandina u lečenju invazivne aspergiloze [3.75 (0.89, 15.76)]. Zaključak. Triazoli (pre svega vorikonazol) se mogu smatrati efikasnijom i, ponekad, manje bezbednom terapijskom opcijom nego ehinokandini za lečenje invazivne aspergiloze. Ipak, zbog slabog kvaliteta studija u ovoj meta-analizi, definitivni zaključak treba da sačeka dodatne, bolje dizajnirane studije.
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