Effectiveness of fluconazole as antifungal prophylaxis in cancer patients undergoing chemotherapy, radiotherapy, or immunotherapy: systematic review and meta-analysis.

Autor: Ramírez-Carmona W; Department of Preventive and Restorative Dentistry, School of Dentistry, Araçatuba, São Paulo State University (Unesp), Araçatuba/São Paulo, Brazil., Fernandes GLP; Department of Preventive and Restorative Dentistry, School of Dentistry, Araçatuba, São Paulo State University (Unesp), Araçatuba/São Paulo, Brazil., Díaz-Fabregat B; Department of Preventive and Restorative Dentistry, School of Dentistry, Araçatuba, São Paulo State University (Unesp), Araçatuba/São Paulo, Brazil., Oliveira EC; Department of Preventive and Restorative Dentistry, School of Dentistry, Araçatuba, São Paulo State University (Unesp), Araçatuba/São Paulo, Brazil., do Prado RL; School of Dentistry, Presidente Prudente, University of Western São Paulo (UNOESTE), Presidente Prudente/São Paulo, Brazil., Pessan JP; Department of Preventive and Restorative Dentistry, School of Dentistry, Araçatuba, São Paulo State University (Unesp), Araçatuba/São Paulo, Brazil., Monteiro DR; Department of Preventive and Restorative Dentistry, School of Dentistry, Araçatuba, São Paulo State University (Unesp), Araçatuba/São Paulo, Brazil.; School of Dentistry, Presidente Prudente, University of Western São Paulo (UNOESTE), Presidente Prudente/São Paulo, Brazil.; Postgraduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente/São Paulo, Brazil.
Jazyk: angličtina
Zdroj: APMIS : acta pathologica, microbiologica, et immunologica Scandinavica [APMIS] 2023 Nov; Vol. 131 (11), pp. 668-684. Date of Electronic Publication: 2023 May 18.
DOI: 10.1111/apm.13324
Abstrakt: This review assessed the effectiveness of fluconazole as antifungal prophylaxis on the incidence of oral fungal diseases in patients undergoing cancer treatment. The secondary outcomes evaluated were the adverse effects, discontinuation of cancer therapy due to oral fungal infection, mortality by a fungal infection, and the mean duration of antifungal prophylaxis. Twelve databases and records were searched. The RoB 2 and ROBINS I tools were used to assess the risk of bias. The relative risk (RR), risk difference, and standard mean difference (SMD) were applied with 95% confidence intervals (CI). The certainty of the evidence was determined by GRADE. Twenty-four studies were included in this systematic review. In randomized controlled trials pooling, fluconazole was a protective factor for the primary outcome (RR = 0.30; CI: 0.16, 0.55; p < 0.01, vs placebo). Compared to other antifungals, fluconazole was only more effective than the subgroup of amphotericin B and nystatin (alone or in combination) (RR = 0.19; CI: 0.09, 0.43; p < 0.01). Fluconazole was also a protective factor in non-randomized trials pooling (RR = 0.19; CI: 0.05, 0.78; p = 0.02, vs untreated). The results showed no significant differences for the secondary outcomes. The certainty of the evidence was low and very low. In conclusion, prophylactic antifungals are necessary during cancer treatment, and fluconazole was shown to be more effective in reducing oral fungal diseases only compared with the subgroup assessing amphotericin B and nystatin, administered alone or in combination.
(© 2023 Scandinavian Societies for Pathology, Medical Microbiology and Immunology.)
Databáze: MEDLINE
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