Should Voriconazole be the Primary Therapy for Chronic Invasive Sinus Aspergillosis (CISA)?
Abstract:Background: The endonasal endoscopic surgery has stood the test of time in managing inflammatory as well as other diseases affecting nose and paranasal sinuses.Objective: To report our experience with endonasal endoscopic surgery of benign tumors and tumor-like conditions of the nose and paranasal sinuses.
Methods:The medical records of 92 patients with tumors and tumor-like conditions, who had undergone endoscopic surgery for removal of their lesions between 1999 and 2010, were retrospectively studied.
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“…Figure 2 presents the results of the systematic bias analysis. There was a low risk of bias for most items, except for the presence of performance and detection bias due to the lack of a double-blind design and blind outcome assessment in four studies [ 18 , 22 , 27 , 32 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Nephrotoxicity could be analyzed for 9 RCTs involving 2530 patients [ 20 – 22 , 28 – 32 ]. The rate of the abnormal renal function was significantly lower in the VRC group than in the counterparts group (10.0% vs. 17.1%) (OR = 0.46, 95% CI = 0.26–0.84, P = 0.02; I 2 = 67%) (Fig.…”
BackgroundVoriconazole 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.MethodsBibliography 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.ResultsAnalysis 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).ConclusionOur 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.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2913-8) contains supplementary material, which is available to authorized users.
“…Figure 2 presents the results of the systematic bias analysis. There was a low risk of bias for most items, except for the presence of performance and detection bias due to the lack of a double-blind design and blind outcome assessment in four studies [ 18 , 22 , 27 , 32 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Nephrotoxicity could be analyzed for 9 RCTs involving 2530 patients [ 20 – 22 , 28 – 32 ]. The rate of the abnormal renal function was significantly lower in the VRC group than in the counterparts group (10.0% vs. 17.1%) (OR = 0.46, 95% CI = 0.26–0.84, P = 0.02; I 2 = 67%) (Fig.…”
BackgroundVoriconazole 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.MethodsBibliography 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.ResultsAnalysis 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).ConclusionOur 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.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2913-8) contains supplementary material, which is available to authorized users.
“…In their study with treatment with voriconazole, Bansal and Gupta reported that many patients developed skin rashes on voriconazole, but were transient and did not hamper the administration of voriconazole to the patients and disappeared after the stopping of the drug. 52 Invasive fungal sinusitis is on the rise worldwide and especially in North India as it is endemic in this part of the country. It is affecting immunocompetent young and middle aged population causing a great morbidity and mortality.…”
Section: Aijcrmentioning
confidence: 99%
“…The results were not favorable with voriconazole in the intradural involvement probably due to the treatment duration of 14 weeks only (Figs 5 and 6). 52 A treatment of 6 to 12 months is being advocated in skull base aspergillosis these days. 15,16 Rhinocerebral aspergillosis carries a high mortality, especially in immune-suppressed patients and after bone marrow transplantation.…”
Invasive sinus Aspergillus infection has been reported in the last decade with increased frequency, most commonly in the setting of hematologic malignancy, neutropenia, HIV infection and other states of immunosuppression. Fungal rhinosinusitis can be broadly classified into two varieties-invasive and noninvasive on the basis of tissue invasion. Invasive fungal sinusitis are acute invasive, chronic invasive (both granulomatous and nongranulomatous forms), whereas noninvasive are fungus balls and allergic fungal sinusitis. Invasive fungal sinusitis is one of the most challenging forms of sinonasal pathology to manage, most commonly presenting in immunocompromised individuals. Chronic invasive being sinus aspergillosis (CISA) is being reported in immunocompetent patients at an increasing rate while most of these cases are being reported from the India subcontinent and middle east. Invasive fungal sinusitis is on the rise worldwide and especially in north India as it is endemic in this part of the country. It is affecting immunocompetent young and middle aged population causing a great morbidity and mortality. This entity needs to be picked up early by spreading awareness among the family physicians, internists, otolaryngologists, ophthalmologists, neurosurgeons, pulmonary physicians, critical care specialists so that an early management can initiated to achieve better control over the disease. This review is an attempt to initiate an interdisciplinary approach to achieve a better outcome.
BackgroundSelecting the optimal surgical approach for resection of sinonasal inverted papilloma (SIP) remains a challenge, with endoscopic, external, and combined approaches being utilized. This systematic review was conducted as an update to a 2006 systematic review to determine the preferred surgical approach for tumor control.MethodsThe study protocol was developed a priori following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) process. Data were collected and outcomes were analyzed according to surgical approach and sites of tumor involvement.ResultsA total of 96 papers and 4134 SIP patients were included. The overall recurrence rate was 12.80% (322/2515) for the endoscopic approach group, 16.58% (182/1098) for the external approach group, and 12.60% (65/516) for the combined approach group. Meta‐analysis by random effects model showed that the summarized risk ratio (RR) of recurrence was 0.61 (95% confidence interval [CI], 0.44 to 0.85, p = 0.003), I2 = 37.95% for the endoscopic vs external approach; 0.98 (95% CI, 0.69 to 1.39, p = 0.901), I2 = 9.06% for the endoscopic vs combined approach; 1.61 (95% CI, 1.06 to 2.43, p = 0.025), I2 = 0.00% for the external vs combined approach. After adjusting for publication bias, the adjusted RRs were 0.66 (p = 0.014) for endoscopic vs external; 0.99 (p = 0.955) for endoscopic vs combined; and 1.33 (p = 0.224) for external vs combined.ConclusionAn enlarging and maturing body of literature continues to indicate that endoscopic approaches result in significantly lower recurrence rates than open approaches for surgical resection of SIP.
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