Comparison of liposomal amphotericin B alone and in combination with flucytosine in the treatment of non-HIV Cryptococcal meningitis: A nationwide observational study.
BACKGROUND: Cryptococcal meningitis (CM) is an opportunistic infectious disease that occurs in immunocompromised hosts, not only in patients living with HIV, but also in patients without HIV. The evidence regarding the treatment for CM in patients without HIV is mainly found in small retrospective studies and is extremely limited.
OBJECTIVES: In the present study, we compared the efficacy of liposomal amphotericin B (L-AMB) alone and in combination with flucytosine (5-FC) for the induction treatment of CM in patients without HIV. PATIENTS/METHODS: Data were gathered from the Japanese Diagnosis Procedure Combination database obtained from hospitals throughout Japan. The study included 517 patients without HIV but having CM who fulfilled the inclusion and exclusion criteria. We analysed the average effect of adding 5-FC to L-AMB treatment using the survival time within 14 days of the diagnosis after adjustment of the baseline clinical characteristics with associations with both selections of the treatment and the prognosis.
RESULTS: A total of 146 and 217 CM patients received L-AMB and L-AMB with 5-FC, respectively, within 7 days of diagnosis. L-AMB with 5-FC showed better prognosis than L-AMB on day 14 (mortality 6% vs. 11%, hazard ratio, 0.5775; 95% confidence interval, 0.2748-1.213; p = 0.1, Wald test).
CONCLUSIONS: From the results of this real-world database study, we revealed that the combination therapy of 5-FC on L-AMB for induction therapy might have an advantage on the survival time of NHNT patients with CM as well as PLHIV patients with CM.
|投稿者||Takazono, Takahiro; Hidaka, Yusuke; Morimoto, Shimpei; Tashiro, Masato; Ashizawa, Nobuyuki; Hirayama, Tatsuro; Takeda, Kazuaki; Iwanaga, Naoki; Hosogaya, Naoki; Yamamoto, Kazuko; Fushimi, Kiyohide; Yanagihara, Katsunori; Mukae, Hiroshi; Izumikawa, Koichi|
|組織名||Department of Infectious Diseases, Nagasaki University Graduate School of;Biomedical Sciences, Nagasaki, Japan.;Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki,;Japan.;Department of General Internal Medicine, National Hospital Organization Nagasaki;Medical Center, Nagasaki, Japan.;Innovation Platform & Office for Precision Medicine, Nagasaki University Graduate;School of Biomedical Sciences, Nagasaki, Japan.;Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan.;Infection Control and Education Center, Nagasaki University Hospital, Nagasaki,;Department of Pharmacotherapeutics, Nagasaki University Graduate School of;Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School, Tokyo, Japan.;Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.|