A study published in Mycoses reported that for the initial treatment of chronic pulmonary aspergillosis (CPA), oral itraconazole can be preferred over other azoles. Regarding the intravenous agents, voriconazole and echinocandins can be preferred over amphotericin B. This network meta-analysis and systematic review were carried to explore the relative efficacy of different anti-fungal agents in CPA management.

Databases such as Embase and PubMed were explored to identify either randomized-controlled trials [RCTs] or observational studies that reported therapy outcomes with anti-fungal agents in CPA people. Utilizing the Newcastle-Ottawa scale (NOS), an assessment of the study quality was done. The major endpoint was a favorable response to therapy with anti-fungal agents.

In total, 10 studies (718 patients) exploring different anti-fungal agents (intravenous anti-fungal agents [n = 5], oral anti-fungal agents [n = 5]) to treat CPA. There were 6 observational studies and 4 RCTs. The studies in which oral agents were used reported long-term outcomes (>12 weeks), while those studies in which intravenous agents were used offered only short-term outcomes (<6 weeks). For the management of CPA, one study of posaconazole was reported while no study of isavuconazole was reported.

Considering the oral agents, itraconazole was remarkably better compared to supportive care. On a network rank analysis, itraconazole was ranked as the best oral AFA. All the intravenous anti-fungal agents were reported to be equally effective. Intravenous voriconazole and echinocandins were ranked best to attain a positive therapeutic response. However, there is a requisition of randomized-controlled trials comparing different anti-fungal agents, particularly the novel anti-fungal agents, concluded the study authors.