Sehgal IS, Dhooria S, Prasad KT, et al. - Given that oral itraconazole and voriconazole are currently recommended in the initial management of chronic pulmonary aspergillosis (CPA), but only a few studies have compared outcomes with different anti-fungal agents (AFAs) in treating CPA, researchers sought to assess the relative effectiveness of different AFAs in CPA. PubMed and EmBase databases were searched to identify studies (either randomized-controlled trials [RCTs] or observational) reporting treatment outcomes with AFAs in CPA. They found ten studies (718 patients) examining different AFAs (oral AFAs [n = 5], intravenous AFAs [n = 5]) in the treatment of CPA. According to this systematic review and network meta-analysis, for initial therapy in CPA, oral itraconazole may be preferable to other azoles. Echinocandins and voriconazole may be preferred over amphotericin B as intravenous agents. Randomized controlled trials comparing various AFAs, particularly newer AFAs, are desperately needed.