Fluconazole versus itraconazole for antifungal prophylaxis in neutropenic patients with haematological malignancies:: a meta-analysis of randomised-controlled trials

Fluconazole and itraconazole are used as antifungal prophylaxis in neutropenic patients with haematological malignancies. A meta-analysis of randomised-controlled trials (RCTs) was performed in order to compare their safety and effectiveness in this population. Data were obtained from PubMed, Current Contents, Cochrane Central Register for Controlled Trials and references from relevant articles. Five RCTs were included in the analysis. Publication bias and statistically significant heterogeneity was not observed among the analysed studies. Fewer patients were withdrawn due to the development of adverse effects associated with fluconazole when compared with itraconazole [odds ratio (OR) 0.27, 95% confidence interval (CI): 0.18-0.41]. On the contrary, prophylactic use of fluconazole resulted in significantly more fungal infections (documented and suspected infections combined, OR 1.62, 95% CI: 1.06 - 2.48). There were no statistically significant differences regarding documented fungal infections (OR 1.51, 95% CI: 0.97-2.35), invasive fungal infections (OR 1.44, 95% CI: 0.96 2.17), overall mortality (OR 0.89, 95% CI: 0.63-1.24) and mortality attributed by the authors to fungal infections (OR 1.30, 95% CI: 0.75-2.25) between the two medications. These data suggest that, even though itraconazole is more effective than fluconazole in the prevention of fungal infections in neutropenic patients with haematological malignancies, the development of more adverse effects may limit its use.