OBJECTIVES:

Determine the efficacy and safety of voriconazole compared to other available antifungal therapies for first-line treatment of invasive aspergillosis (IA) in adults.

METHODS:

A systematic review was performed to find randomized controlled trials (RCTs) that compared to antifungal therapies for the treatment of IA. The search was executed in MEDLINE, COCHRANE, EMBASE, LILACS and clinicaltrials.gov databases. RCT selection, data extraction, and risk of bias assessment according to Cochrane criteria were performed by two researchers independently. Outcomes of interest included global response, all-cause mortality, hepatoxicity, and nephrotoxicity. Bayesian analysis was used to perform the network meta-analysis (NMA) in order to execute indirect comparison of voriconazole to other antifungal therapies. Additionally, the quality of evidence was assessed using the GRADE methodology. The results were expressed in difference of risk (DR).

RESULTS:

We identified 2 RCTs, which compared voriconazole with amphotericin B deoxycolate (AmB), and AmB with Amphotericin B colloidal dispersion (AmBCD). Voriconazole was superior to AmpB in global response (DR -0.21, 95%CI -0.34 – (-0.07)), all-cause mortality (DR 0.13, 95%CrI 0.02-0.24) and nephrotoxicity (DR 0.09, 95%CI 0.05-0.14). In the case of AmBCD, there were differences which may be relevant clinically compared to voriconazole in the outcomes evaluated, however, they were not statistically significant. Voriconazole had the highest probability to be the best treatment in all outcomes except hepatoxicity. The heterogeneity in each analysis was low. The quality of the evidence was moderate to very low in the majority of the outcomes mainly due to risk of bias and imprecision.

CONCLUSIONS:

The NMA suggested that voriconazole was superior to AmB in terms of efficacy and safety. In the case of AmBCD, the comparison with voriconazole did not find statistical differences. There were limited numbers of RCTs for this systematic review.