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Research Article
Re-Appraisal of Effective, and Tolerable Induction Regimens for Managing Cryptococcal Meningitis in HIV-Infected Adults: A Systematic Review and Network Meta-Analysis
Yu-Kang Tu
National Taiwan University Hospital
Corresponding Author
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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.
Keywords
Cryptococcal meningitis, human immunodeficiency virus, anti-fungal agents, tolerability
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This preprint is under consideration at Scientific Reports. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Re-Appraisal of Effective, and Tolerable Induction Regimens for Managing Cryptococcal Meningitis in HIV-Infected Adults: A Systematic Review and Network Meta-Analysis
Yu-Kang Tu
National Taiwan University Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 31 Dec, 2020
No community comments so far
Review #2 received
Received 08 Jan, 2021
Review #1 received
Received 08 Jan, 2021
Review #3 received
Received 08 Jan, 2021
Review #5 received
Received 08 Jan, 2021
Review #4 received
Received 08 Jan, 2021
Reviewer #3 agreed
On 07 Jan, 2021
Reviewer #2 agreed
On 07 Jan, 2021
Reviewer #4 agreed
On 07 Jan, 2021
Reviewer #6 agreed
On 07 Jan, 2021
Reviewer #1 agreed
On 07 Jan, 2021
Reviewer #5 agreed
On 07 Jan, 2021
Reviewers invited
Invitations sent on 05 Jan, 2021
Editor assigned
On 05 Jan, 2021
Editor invited
On 30 Dec, 2020
Submission checks complete
On 30 Dec, 2020
First submitted
On 04 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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