Re-Appraisal of Effective, and Tolerable Induction Regimens for Managing Cryptococcal Meningitis in HIV-Infected Adults: A Systematic Review and Network Meta-Analysis
Cryptococcal meningitis (CM) has become the most fatal adult meningitis in patients with human immunodeficiency virus (HIV). There is no conclusive evidence for the superiority of one-week amphotericin B deoxycholate (AmphB) + flucytosine (5-FC) regimen over other antifungals in the management of HIV patients with CM (HIV-CM patients). We aimed to evaluate the differences in efficacy and tolerability of different antifungal agents in HIV-CM patients by conducting a current network meta-analysis NMA. Overall, 19 randomized controlled trials were included with 2,642 participants. A regimen indicated a possibly lower early mortality rate, namely, AmphB + 5-FC + High dose azole (Azole_H) (OR = 1.1*10− 12, 95% CIs = 1.3*10− 41 to 0.06) comparing to AmphB + 5-FC. Azole_H was possibly associated with the lowest late-mortality rate (OR = 0.27, 95% CIs = 0.08 to 0.99). The current NMA provides evidence that AmphB + 5-FC + Azole_H are superior to all the investigated treatments for induction regimen in HIV-CM patients.
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Posted 31 Dec, 2020
Received 08 Jan, 2021
Received 08 Jan, 2021
Received 08 Jan, 2021
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Received 08 Jan, 2021
On 07 Jan, 2021
On 07 Jan, 2021
On 07 Jan, 2021
On 07 Jan, 2021
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On 07 Jan, 2021
Invitations sent on 05 Jan, 2021
On 05 Jan, 2021
On 30 Dec, 2020
On 30 Dec, 2020
On 04 Dec, 2020
Re-Appraisal of Effective, and Tolerable Induction Regimens for Managing Cryptococcal Meningitis in HIV-Infected Adults: A Systematic Review and Network Meta-Analysis
Posted 31 Dec, 2020
Received 08 Jan, 2021
Received 08 Jan, 2021
Received 08 Jan, 2021
Received 08 Jan, 2021
Received 08 Jan, 2021
On 07 Jan, 2021
On 07 Jan, 2021
On 07 Jan, 2021
On 07 Jan, 2021
On 07 Jan, 2021
On 07 Jan, 2021
Invitations sent on 05 Jan, 2021
On 05 Jan, 2021
On 30 Dec, 2020
On 30 Dec, 2020
On 04 Dec, 2020
Cryptococcal meningitis (CM) has become the most fatal adult meningitis in patients with human immunodeficiency virus (HIV). There is no conclusive evidence for the superiority of one-week amphotericin B deoxycholate (AmphB) + flucytosine (5-FC) regimen over other antifungals in the management of HIV patients with CM (HIV-CM patients). We aimed to evaluate the differences in efficacy and tolerability of different antifungal agents in HIV-CM patients by conducting a current network meta-analysis NMA. Overall, 19 randomized controlled trials were included with 2,642 participants. A regimen indicated a possibly lower early mortality rate, namely, AmphB + 5-FC + High dose azole (Azole_H) (OR = 1.1*10− 12, 95% CIs = 1.3*10− 41 to 0.06) comparing to AmphB + 5-FC. Azole_H was possibly associated with the lowest late-mortality rate (OR = 0.27, 95% CIs = 0.08 to 0.99). The current NMA provides evidence that AmphB + 5-FC + Azole_H are superior to all the investigated treatments for induction regimen in HIV-CM patients.
Figure 1
Figure 2
Figure 3