To evaluate the effectiveness and safety of posaconazole in antifungal prophylaxis.

CNKI, VIP, CBM, Wangfang Database, PubMed, Cochrane Library, Embase, OVID, and Web of Science from the inception to March 2014 were searched. The randomized controlled trials (RCT) which compared posaconazole with placebo or other antifungal drugs in antifungal prophylaxis and the endpoint was the incidences of invasive fungal infection (IFI), all-cause mortality, or adverse reactions were collected. The related information was selected and RevMan 5.1 software of Cochrane Collaboration was used for statistical analysis. The results were expressed as odds ratios (OR) and its corresponding 95% confidence intervals (CI).

A total of 6 RCTs were enrolled into the study. Of them, 4 RCTs were comparison of posaconazole with one other antifungal drug, and 2 RCTs were comparison of posaconazole with two kinds of other antifungal drugs. There were 1 410 cases in the experimental group and 929 cases in the control group. The results of Meta-analysis showed that the incidence of IFI in the experimental group was lower than that in the control group (OR=0.37, 95%CI: 0.27-0.50, P<0.000 01). The results of comparison of posaconazole with other antifungal drugs showed that the incidence of invasive fungal infections in the experimental group were lower than those in the fluconazol group (OR=0.42, 95% CI: 0.28-0.64, P<0.000 1) and the itraconazole group (OR=0.33, 95% CI: 0.21-0.53, P<0.000 01). There were no statistical significant differences in incidence of invasive fungal infections between the experimental group and the control groups of voriconazole and amphotericin B (OR=0.13, 95% CI: 0.01-2.67, P=0.19; OR=0.11, 95% CI: 0.01-2.34, P=0.16). The incidence of invasive mold infection in the experimental group was lower than that in the fluconazole group (OR=0.25, 95% CI: 0.12-0.51, P=0.000 1) . There was no statistical significant difference in incidence of invasive mold infection between the experimental group and the itraconazole group (OR=0.10, 95% CI: 0.01-1.59, P=0.10). There were no statistical significant differences in incidence of invasive candida infection between the experimental group and the control groups of fluconazol and itraconazole (P=0.91, P=0.33). The all-cause mortality in the experimental group was lower than that in the control group (OR=0.64, 95% CI: 0.49-0.82, P=0.000 5). The incidence of adverse reactions in the experimental group was lower than that in the control group (OR=0.81, 95% CI: 0.66-0.99, P=0.04); but the result of subgroup analysis showed that there were no statistical significant difference in the incidence of adverse reactions between the experimental group and the control groups such as fluconazol, itraconazole, voriconazole, and amphotericin B liposomes (all P>0.05). It was considered that publication bias existed in above-mentioned 6 RCTs.

The effectiveness of posaconazole in antifungal prophylaxis is better than those in the non-posaconazole drugs and the safety of posaconazole is similar to the non-posaconazole drugs.

Posaconazole; Protective agents; Safety; Mata-analysis