The online version of this article (https://doi.org/10.1186/s12879-017-2913-8) contains supplementary material, which is available to authorized users.
Voriconazole has been used in the treatment and prophylaxis of invasive fungal infections (IFIs) while its wide use was limited by some frequent adverse events, especially neurotoxicity, hepatotoxicity and even renal disruption. The aim of this study was to comprehensively compare voriconazole-induced toxicity, including tolerability, neurotoxicity, visual toxicity, hepatotoxicity and nephrotoxicity with the composite of other antifungals commonly used in clinic.
Bibliography databases were searched to select randomized controlled trials providing information about the incidence of toxicity referred above. A total of 4122 patients from 16 studies were included in the meta-analysis.
Analysis of individual types of toxicity showed that there was a significant difference between voriconazole and the composite of other antifungal agents. The primary outcome, the tolerability of voriconazole was slightly inferior (OR = 1.71, 95% CI = 1.21–2.40, P = 0.002) and it is noteworthy that the probabilities of neurotoxicity and visual toxicity were around twice higher and six-fold for voriconazole compared with the counterpart (OR = 1.99, 95% CI = 1.05–3.75, P = 0.03 and OR = 6.50, 95% CI = 2.93–14.41, P < 0.00001, respectively). Hepatotoxicity was more common in voriconazole group (OR = 1.60, 95% CI = 1.17–2.19, P = 0.003) whereas its pooled risk of nephrotoxicity was about half of the composite of other five antifungal agents (OR = 0.46, 95% CI = 0.26–0.84, P = 0.01).
Our analysis has revealed differences in multiple types of toxicity induced by VRC versus other antifungals and quantified the corresponding pooled risks, which could provide an alternative for patients with a certain antifungal intolerance and help the clinician to select the optimal intervention.
Additional file 1: Detailed searching strategy. It provided more detail about the searching strategy we used in the present study. (PDF 105 kb)
Additional file 2: Sensitive analysis and the funnel plots under the five outcomes. The sensitive analysis part included the influence of individual study involved in the evaluation of tolerability, neurotoxicity, visual toxicity, hepatotoxicity and nephrotoxicity (see in Figure S1-S5). (PDF 433 kb)
Additional file 3: A summary of sensitive analysis for voriconazole safety after excluding a group of studies which was considered as the potential impact factors to the final results was shown in Table S1. (PDF 33 kb)
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- Meta-analysis of the safety of voriconazole in definitive, empirical, and prophylactic therapies for invasive fungal infections
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