Efficacy and Safety of Antifungal Medicines in the Treatment of Invasive Aspergillosis: A Network Meta-Analysis

A frequentist network meta-analysis (NMA) was conducted to assess the efficacy and safety of voriconazole, posaconazole, isavuconazole, amphotericin B deoxycholate (AmB-D), and liposomal AmB (L-AmB) in the treatment of invasive aspergillosis (IA). This study searched PubMed, Cochrane Library, and Embase from the beginning till December 31, 2023. It included five randomised controlled trials (RCTs) of 1635 patients with confirmed or suspected IA. Compared to AmB-D, posaconazole (odds ratio (OR): 0.39, 95% confidence interval (CI): [0.20, 0.76]), isavuconazole (OR: 0.51, 95% CI: [0.26, 0.99]), and voriconazole (OR: 0.57, 95% CI: [0.34, 0.93]) were significantly effective in reducing all-cause mortality. Similarly, voriconazole (OR: 2.42, 95% CI: [1.48, 3.96]), posaconazole (OR: 2.34, 95% CI: [1.22, 4.50]), and isavuconazole (OR: 2.27, 95% CI: [1.13, 4.57]) also showed significantly greater efficacy in improving overall response compared to AmB-D. The area under the cumulative ranking curve (SUCRA) results showed that posaconazole was the most effective in reducing all-cause mortality, while voriconazole ranked best in overall response. In conclusion, this NMA suggests that for IA, posaconazole, isavuconazole, voriconazole, and L-AmB are all effective first-line treatment options. However, more RCTs are needed to validate these findings further. Key Words: Invasive aspergillosis, Posaconazole, Isavuconazole, Voriconazole, Network meta-analysis.