Abstract

Invasive aspergillosis (IA) is a life-threatening infection, particularly in immunocompromised patients, with an estimated annual incidence exceeding 300,000 cases worldwide. This study compares the antifungal drugs of azoles, amphotericin B, and echinocandins based on primary and salvage treatment outcomes. This systematic review and meta-analysis included studies using IA diagnostic criteria from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. The review followed the Preferred Reported Items for Systematic Review and Meta-analysis 2020 guidelines. Data were analyzed for response and survival outcomes. A total of 264 studies (1997–2019) were screened, with 10 studies included for analysis, consisting of six randomized controlled trials (RCTs) and four non-RCTs/ cohorts involving 2,162 patients. New triazoles demonstrated a significantly higher favorable response in salvage treatment [odds ratio (OR) 2.31, p = 0.003] but not in primary treatment. Echinocandins exhibited no superiority in either setting. Survival rates after 6–12 weeks were higher with new triazoles (OR 1.59, p < 0.001), while echinocandins showed no significant advantage. Voriconazole remains the preferred primary treatment for IA, while posaconazole is superior for salvage therapy, with isavuconazole as an alternative due to fewer adverse effects. Amphotericin B has roles in treatment but requires careful consideration due to toxicity risks.

Key words: invasive aspergillosis, antifungal, primary, salvage, response, survival.