DataSheet_1_What Is the Most Appropriate Induction Regimen for the Treatment of HIV-Associated Cryptococcal Meningitis When the Recommended Regimen Is Not Available? Evidence From a Network Meta-Analysis.doc
Our object was to find the most appropriate, most effective, and most readily available of four induction regimens for HIV-associated cryptococcal meningitis (CM) (Regimen A: 1 week of AmB plus 5-FC followed by 1 week of fluconazole, Regimen B: 1 week of AmB plus fluconazole followed by 1 week of fluconazole, Regimen C: 2 weeks of AmB plus 5-FC, Regimen D: 2 weeks of AmB plus fluconazole), given the vast differences between resource-limited and resource-abundant settings regarding therapeutic drug accessibility, availability, and affordability for HIV-associated (CM).
MethodsWe conducted a network meta-analysis to compare the therapeutic efficacy and safety of four different induction treatment regimens.
ResultsThe 10-week mortality of Regimen A was significantly lower than that of Regimen B and D, and the 2-week mortality of Regimen A was significantly lower than that of Regimen B. Furthermore, there were no statistically significant differences in 10-week mortality, 2-week mortality, as well as in effective fungicidal activity (EFA) over the first 2 weeks among Regimens B, C, and D. The statistical differences in adverse events between Regimen B and Regimen D, and Regimen C and Regimen D were not calculated to be significant.
ConclusionsOur results indicate that, 1 week of AmB plus 5-FC followed by 1 week of fluconazole is superior to the three other studied regimens, and that when 5-FC is not available, accessible, or affordable, 2 weeks of AmB plus fluconazole or 1 week of AmB plus fluconazole followed by 1 week of fluconazole is an appropriate substitution for 2 weeks of AmB plus 5-FC.
History
References
- https://doi.org//10.1056/NEJMoa1509024
- https://doi.org//10.1097/QAD.0b013e32832605fe
- https://doi.org//10.1128/AAC.01698-15
- https://doi.org//10.12688/f1000research.17673
- https://doi.org//10.1016/S0140-6736(04)16301-0
- https://doi.org//10.1371/journal.pone.0076654
- https://doi.org//10.1016/S0140-6736(09)60046-5
- https://doi.org//10.1056/NEJMc1305981
- https://doi.org//10.1136/bmj.d5928
- https://doi.org//10.3389/fphar.2018.00890
- https://doi.org//10.1093/cid/ciy51
- https://doi.org//10.1016/S2352-3018(16)30091-1
- https://doi.org//10.1093/jac/dkw325
- https://doi.org//10.1097/QCO.0000000000000514.10.1016/j.ijid.2017.08.004
- https://doi.org//10.1093/cid/cir745
- https://doi.org//10.1093/jac/dkt221
- https://doi.org//10.1016/S1473-3099(13)70078-1
- https://doi.org//10.1016/S1473-3099(18)30493-6
- https://doi.org//10.1093/cid/ciw151
- https://doi.org//10.1186/2046-4053-4-1
- https://doi.org//10.1056/NEJMoa1710922
- https://doi.org//10.3390/jof3040067
- https://doi.org//10.1093/ofid/ofy267
- https://doi.org//10.1093/cid/ciaa016
- https://doi.org//10.1371/journal.pmed.1001316
- https://doi.org//10.1016/S1473-3099(17)30243-8
- https://doi.org//10.1016/S1473-3099(16)00074-8
- https://doi.org//10.1016/S1473-3099(19)30127-6
- https://doi.org//10.1016/j.jclinepi.2010.03.016
- https://doi.org//10.4178/epih.e2017047
- https://doi.org//10.1016/B978-0-444-63849-6.00011-6
- https://doi.org//10.1002/14651858
- https://doi.org//10.18549/PharmPract.2017.01.943
- https://doi.org//10.1186/s12874-017-0390-9
- https://doi.org//10.1177/1536867X1501500403
- https://doi.org//10.1007/s10096-014-2074-2
- https://doi.org//10.1186/s12879-015-0826-y