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Antifungal agents in preventing oral candidiasis in clinical oncology: A network meta-analysis

Yee Shen Loo1, Tse Yee Wong1, Sajesh K Veettil2

  • 1School of Pharmacy, International University Medical, Kuala Lumpur, Malaysia.

Oral Diseases
|August 8, 2020
PubMed
Abstract

Insights

Clotrimazole best prevents oral candidiasis in cancer patients, while fluconazole offers the best safety profile. Further research is needed to confirm clotrimazole

Area of Science:

  • Oncology
  • Infectious Diseases
  • Pharmacology

Background:

  • Cancer patients undergoing treatment are at high risk for opportunistic infections like oral candidiasis.
  • Antifungal prophylaxis is crucial for managing and preventing oral candidiasis in this vulnerable population.
  • Comparative data on the efficacy and safety of various antifungal agents is essential for clinical decision-making.

Purpose of the Study:

  • To systematically review and network meta-analyze the comparative efficacy and safety of antifungal agents for preventing oral candidiasis in cancer patients.
  • To rank antifungal agents based on their effectiveness and safety profiles using surface under the cumulative ranking (SUCRA) scores.

Main Methods:

  • Systematic review and network meta-analysis of randomized controlled trials (RCTs).
  • Inclusion of 20 RCTs with 3,215 participants comparing 11 antifungal interventions against placebo or other antifungals.
  • Evaluation of relative rankings using SUCRA probability scores.

Main Results:

  • Clotrimazole demonstrated the highest efficacy in preventing oral candidiasis compared to placebo (RR, 0.21; SUCRA = 0.89).
  • Fluconazole was ranked highest for safety among antifungal agents (SUCRA = 0.80).
  • Amphotericin B showed the highest risk of adverse events (RR, 3.52) and was ranked low for safety (SUCRA = 0.18), as was clotrimazole (SUCRA = 0.36).

Conclusions:

  • Clotrimazole is the most effective agent for preventing oral candidiasis in cancer patients.
  • Fluconazole possesses the most favorable risk-benefit profile.
  • Despite its efficacy, clotrimazole cannot be definitively recommended due to a lack of direct comparative studies with other antifungals.
Keywords:
antifungal agentscancernetwork meta-analysisoral candidiasispreventionsystematic review

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