Newer antifungal agents micafungin and voriconazole for fungal infection prevention during hematopoietic cell transplantation: a meta-analysis

OBJECTIVE: The new antifungal agents provide further opportunities for effective prophylaxis for fungal infections during stem cell transplantation for patients with hematologic malignancies; however, the efficacy of these antifungal prophylactic drugs has not yet been established. This study was to compare the newer antifungal agents micafungin and voriconazole for prophylaxis effects on the clinical outcomes. MATERIALS AND METHODS: We electronically searched the database of Cochrane Central Register of Controlled Trials, Pubmed, EMbase, and relevant database articles (1996.01-2013.12). Comparative studies were carried out on proved fungal infections, mortality, and adverse effects. Meta-analysis was performed by Review Manager 5.1.6 software and the funnel plot regression was adopted to assess the publication bias. RESULTS: We found 1508 records and 13 studies totaling 3767 patients included in analyses. Pooled comparisons of studies found that antifungal prophylaxis with the new agents does reduce the incidence of invasive fungal infections than fluconazole or itraconazole. The reduction in invasive fungal infections was achieved by using micafungin, voriconazole for antifungal prophylaxis. Using voriconazole prophylaxis can decrease the transplant mortality compared with fluconazole or itraconazole prophylaxis. Voriconazole had higher rates of liver dysfunction, lower gastrointestinal side effects over fluconazole, and lower rates of nephrotoxic effects than amphotericin B. Both micafungin and voriconazole had a significant decrease in adverse events requiring drug discontinuation compared with itraconazole. CONCLUSIONS: This analysis indicated the 2 agents appear to be well tolerated with manageable side effects and beneficial in the prophylaxis of IFI. Further work is needed with a large scale of random controlled trials on the effect of these drugs.