PMID- 28700646
OWN - NLM
STAT- MEDLINE
DCOM- 20170926
LR  - 20181202
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 7
DP  - 2017
TI  - Efficacy and safety of micafungin versus extensive azoles in the prevention and 
      treatment of invasive fungal infections for neutropenia patients with 
      hematological malignancies: A meta-analysis of randomized controlled trials.
PG  - e0180050
LID - 10.1371/journal.pone.0180050 [doi]
LID - e0180050
AB  - BACKGROUND: Current studies that compare the efficacy and safety of micafungin 
      (MCFG) with that of triazoles for the prophylaxis and treatment of invasive 
      fungal infections (IFIs) demonstrate a lack of sufficient evidence and yield 
      conflicting results. To compare the efficacy and safety of MCFG and triazoles in 
      the prevention and treatment of IFIs, we conducted a meta-analysis and trial 
      sequential analysis (TSA). METHODS: For the meta-analysis, we systematically 
      searched the databases of PubMed, Embase and Cochrane Central Register of 
      Controlled Trials and relevant database articles for randomized controlled 
      studies published through November 2016. Comparative studies of the efficacy and 
      safety of MCFG versus triazoles in the prevention and treatment of IFIs were 
      selected. Meta-analysis was performed by R software with the "metafor" package. 
      Pooled results were expressed as risk ratios (RRs) with corresponding 95% 
      confidence intervals (CI). TSA was adopted to assess the studies' power with TSA 
      version 0.9 beta. RESULTS: Nine current studies were included in the 
      meta-analysis (1049 cases and 959 controls). Pooled trial comparisons indicated 
      that MCFG does have significantly higher treatment success rates (RR = 1.13; 95% 
      CI, 1.02-1.25; p = 0.0205) and reduces the number of overall IFIs (RR = 0.75; 95% 
      CI, 0.61-0.92; p = 0.0056). However, MCFG demonstrates no difference in all-cause 
      mortality (RR = 0.76; 95% CI, 0.52-1.12, p = 0.1624). For the safety evaluation, 
      MCFG had a significantly lower incidence of severe adverse events (AEs) (RR = 
      0.45; 95% CI, 0.25-0.83; p = 0.0105), hepatic impairment (RR = 0.70; 95% CI, 
      0.50-0.97; p = 0.0363) and premature discontinuation (RR = 0.51; 95% CI, 
      0.34-0.76, p = 0.0010). Meta-regression analysis disclosed the correction of mean 
      age and treatment success rates (P < 0.0001). Meanwhile, TSA demonstrated 
      sufficient power to show efficacy. CONCLUSIONS: The treatment success rate of 
      MCFG is superior to that of triazoles for the prophylaxis and treatment of IFIs, 
      and correction of the mean patient age demonstrates that efficacy increases as 
      patient age decreases. MCFG appears to be well-tolerated with manageable side 
      effects and lower withdrawal rates. However, additional clinical trials should be 
      conducted on specific drug-related mortality and AEs to gather sufficient 
      evidence on these matters.
FAU - Lee, Cho-Hao
AU  - Lee CH
AUID- ORCID: 0000-0002-6061-5168
AD  - Department of Hematology and Oncology Medicine, Tri-Service General Hospital, 
      National Defense Medical Center, Taipei, Taiwan, ROC.
AD  - Department of Internal Medicine, Tri-Service General Hospital, National Defense 
      Medical Center, Taipei, Taiwan, ROC.
FAU - Lin, Jung-Chung
AU  - Lin JC
AD  - Department of Internal Medicine, Tri-Service General Hospital, National Defense 
      Medical Center, Taipei, Taiwan, ROC.
AD  - Department of Infectious Diseases and Tropical Medicine, Tri-Service General 
      Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
FAU - Ho, Ching-Liang
AU  - Ho CL
AD  - Department of Hematology and Oncology Medicine, Tri-Service General Hospital, 
      National Defense Medical Center, Taipei, Taiwan, ROC.
AD  - Department of Internal Medicine, Tri-Service General Hospital, National Defense 
      Medical Center, Taipei, Taiwan, ROC.
FAU - Sun, Min
AU  - Sun M
AD  - Department of General Surgery, Taihe Hospital, Hubei University of Medicine, 
      Shiyan, P.R. China.
FAU - Yen, Wel-Ting
AU  - Yen WT
AD  - School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.
FAU - Lin, Chin
AU  - Lin C
AD  - School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
AD  - Department of Research and Development, National Defense Medical Center, Taipei, 
      Taiwan, ROC.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20170712
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antifungal Agents)
RN  - 0 (Echinocandins)
RN  - 0 (Lipopeptides)
RN  - 0 (Triazoles)
RN  - R10H71BSWG (Micafungin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Antifungal Agents/adverse effects/*therapeutic use
MH  - Child
MH  - Echinocandins/adverse effects/*therapeutic use
MH  - Female
MH  - Humans
MH  - Leukemia/*complications
MH  - Lipopeptides/adverse effects/*therapeutic use
MH  - Male
MH  - Micafungin
MH  - Middle Aged
MH  - Mycoses/complications/*drug therapy/prevention & control
MH  - Neutropenia/*complications
MH  - Randomized Controlled Trials as Topic
MH  - Triazoles/adverse effects/*therapeutic use
PMC - PMC5507498
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2017/07/13 06:00
MHDA- 2017/09/28 06:00
PMCR- 2017/07/12
CRDT- 2017/07/13 06:00
PHST- 2017/03/24 00:00 [received]
PHST- 2017/06/08 00:00 [accepted]
PHST- 2017/07/13 06:00 [entrez]
PHST- 2017/07/13 06:00 [pubmed]
PHST- 2017/09/28 06:00 [medline]
PHST- 2017/07/12 00:00 [pmc-release]
AID - PONE-D-17-11512 [pii]
AID - 10.1371/journal.pone.0180050 [doi]
PST - epublish
SO  - PLoS One. 2017 Jul 12;12(7):e0180050. doi: 10.1371/journal.pone.0180050. 
      eCollection 2017.