Oteseconazole versus fluconazole in the treatment of acute candidiasis: a systematic review and meta-analysis

Objective:  Vulvovaginal candidiasis (VVC) is a common infection traditionally treated with fluconazole. Oteseconazole is a new oral antifungal offering a promising alternative. However, it is essential to assess if it has better efficacy than the treatment already used in VVC.

Methods:  This systematic review and meta-analysis followed PRISMA guidelines, searching PubMed, EMBASE, and Cochrane for studies comparing oteseconazole and fluconazole in acute VVC. Three randomized controlled trials were included. Odds ratios were calculated using a random-effects model.

Results:  The initial search yielded 203 results, but only three RCTs with 593 patients were included. Oteseconazole showed significantly higher rates of therapeutic and sustained clinical cure at day 14 and 28 compared to fluconazole (OR 2.56 and 2.08, respectively), with similar rates of mild to moderate adverse events. Risk of bias was high due to selective reporting.

Conclusion:  Oteseconazole appears to be a safe and more effective alternative to fluconazole for acute VVC, but further research and more robust studies are needed to confirm these findings. PROSPERO Registry: #CRD420251010309

Keywords
Vulvovaginal candidiasis; Fluconazole; Oteseconazole