Tolerability of oral itraconazole and voriconazole for the treatment of chronic pulmonary aspergillosis: A systematic review and meta-analysis
Loading...
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
PloS one
Abstract
Chronic pulmonary aspergillosis (CPA) requires prolonged treatment with itraconazole or
voriconazole. However, adverse events (AEs) are common with the use of these agents,
with the need to discontinue the offending drug in a significant proportion of the patients.
The aim of this study was to evaluate the frequency of adverse events of itraconazole and
voriconazole for the treatment of CPA.
Methods
We searched Embase and Medline to select clinical studies providing information on AEs to
itraconazole or voriconazole for the treatment of CPA from inception to May 2020. Reviews,
single case reports, and case series reporting less than 10 patients were excluded. Random
effect meta-analysis was performed using STATA 16.0.
Results
We included 9 eligible studies with an overall total of 534 CPA patients enrolled. Of these,
69% (n = 366) were treated with voriconazole and 31% (n = 168) with itraconazole. The
median daily dose of both itraconazole and voriconazole used was 400mg. In a pooled analysis,
AEs were observed in 36% (95% CI: 20–52%, N = 366) of patients on voriconazole
and 25% (95% CI: 18 to 31%, N = 168) in those treated with itraconazole. Discontinuation
rate due to AEs was the same for both drugs; 35% (47/366) and 35% (15/168) for voriconazole
and itraconazole, respectively. There were 70 AEs reported with itraconazole use, the
commonest being cardiotoxicity (29%). Skin AEs (28%) were the most frequent among the
204 AEs reported with voriconazole use. None of the studies compared the tolerability of
itraconazole head-to-head with voriconazole. Conclusions
AEs due itraconazole and voriconazole are common and may lead to discontinuation of
treatment in a significant proportion of patients. This information can be used to educate
patients prior to commencement of these antifungal therapies.
Description
Keywords
Tolerability, Oral itraconazole, Voriconazole, Chronic pulmonary aspergillosis
Citation
Olum R, Baluku JB, Kazibwe A, Russell L, Bongomin F (2020) Tolerability of oral itraconazole and voriconazole for the treatment of chronic pulmonary aspergillosis: A systematic review and meta-analysis. PLoS ONE 15(10): e0240374. https://doi.org/10.1371/journal.pone.0240374