Voriconazole versus Liposomal Amphotericin B for Empirical Antifungal Therapy

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Abstract
The report by Walsh et al. (Jan. 24 issue)1 of a trial of voriconazole, as compared with liposomal amphotericin B, for patients with neutropenia and persistent fever and the accompanying editorial and letter to the editor2,3 leave many questions about what the trial actually demonstrated and how the findings should be applied. The abstract implies that the study showed equivalence and concludes, “Voriconazole is a suitable alternative to amphotericin B preparations.” Yet the text and the accompanying editorial point out that the prespecified statistical criterion for equivalence was not met. To confuse the issue further, correspondents from the Food and Drug Administration provide alternative data, indicating that voriconazole was actually statistically inferior to liposomal amphotericin B with respect to overall success rates.3 Thus, whether the study showed equivalence, near equivalence, or frank inferiority remains unclear.

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