Comparative Effectiveness of Amphotericin B, Azoles, and Echinocandins in the Treatment of Candidemia and Invasive Candidiasis: A Systematic Review and Network Meta-Analysis

Mycoses. 2021 Apr 24. doi: 10.1111/myc.13290. Online ahead of print.


BACKGROUND & OBJECTIVES: The echinocandins, amphotericin B preparations, voriconazole, and fluconazole are approved for the treatment of invasive candidiasis, though it remains unclear which agent is most effective. In order to answer this question, we performed a systematic review and network meta-analysis of the randomized controlled trials (RCT) which evaluated these agents in comparison.

METHODS: Four electronic databases were searched from database inception to October 8, 2020. RCTs comparing triazoles, echinocandins, or amphotericin B for the treatment of invasive candidiasis or candidemia were included. Random effect Bayesian network meta-analysis methods were used to compare treatment outcomes.

RESULTS: Thirteen RCTs met inclusion criteria. Of the 3528 patients included from these trials, 1531 were randomized to receive an echinocandin, 944 to amphotericin B, and 1053 to a triazole. For all forms of invasive candidiasis, echinocandins were associated with the highest rate of treatment success when compared to amphotericin B (OR 1.41, 95% CI 1.04 - 1.92) and the triazoles (OR 1.82, 95% CI 1.35 - 2.51). Rank probability analysis favoured echinocandins as the most effective choice 98% of the time. Overall survival did not significantly differ between groups.

CONCLUSIONS: Among patients with invasive candidiasis, echinocandins had the best clinical outcomes and should remain the first-line agents in the treatment of invasive candidiasis.

PMID:33894072 | DOI:10.1111/myc.13290