A Systematic Review of Invasive Fungal Infection Treatment With Voriconazole And Caspofungin Among Chinese Population

Background: Voriconazole has been available in China for 10 years. In this time, there has been clinical studies published on the Chinese population. Objective: This study aimed to conduct a systematic review for both English and Chinese literature on the clinical efficacy and safety of voriconazole versus caspofungin in treating Chinese patients with invasive fungal infection (IFI). Methods: Both English and Chinese terms of “voriconazole” and “infection” were searched accordingly for clinical studies conducted on populations in China, Taiwan, Hong Kong and Macau in several databases. Identified abstracts were filtered independently by two researchers to select eligible studies. A third researcher was consulted for any disagreement. Jadad scale and modified Newcastle-Ottawa tool were used to assess the study quality of the selected studies. Results: Two RCTs and 10 retrospective observational studies were included in the systematic review. Conflicting trends were reported on effective treatment rate in the RCTs. 8 observational studies demonstrated that voriconazole had similar or higher effective treatment rate than caspofungin. Among those observational studies reporting mortality data, 83% demonstrated a lower mortality rate for patients treated with voriconazole. None of these comparisons were found to be statistically significant. Conclusion: The trend of higher effective treatment rates and lower mortality rates of voriconazole compared to caspofungin were observed among Chinese patients with IFI. However, given the small sample size, low study quality, different definitions of efficacy and presence of varied underlying comorbidities in the reviewed studies, the results need to be interpreted with caution.