دورية أكاديمية
Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa
| العنوان: | Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa |
|---|---|
| المؤلفون: | Molloy, SF, Kanyama, C, Heyderman, RS, Loyse, A, Kouanfack, C, Chanda, D, Mfinanaga, S, Temfack, E, Lakhi, S, Lesikari, S, Chan, AK, Stone, N, Kalata, N, Karunaharan, N, Gaskell, K, Peirse, M, Ellis, J, Chawinga, C, Lontsi, S, Ndong, J-G, Bright, P, Lupiya, D, Chen, T, Bradley, J, Adams, J, van der Horst, C, van Oosterhout, JJ, Sini, V, Mapoure, YN, Mwaba, P, Bicanic, T, Lalloo, DG, Wang, D, Hosseinipour, MC, Lortholary, O, Jaffar, S, Harrison, TS, ACTA Trial Study Team |
| بيانات النشر: | Massachusetts Medical Society |
| سنة النشر: | 2018 |
| المجموعة: | St George's University of London: Repository |
| الوصف: | Background Cryptococcal meningitis accounts for more than 100,000 human immunodeficiency virus (HIV)–related deaths per year. We tested two treatment strategies that could be more sustainable in Africa than the standard of 2 weeks of amphotericin B plus flucytosine and more effective than the widely used fluconazole monotherapy. Methods We randomly assigned HIV-infected adults with cryptococcal meningitis to receive an oral regimen (fluconazole [1200 mg per day] plus flucytosine [100 mg per kilogram of body weight per day] for 2 weeks), 1 week of amphotericin B (1 mg per kilogram per day), or 2 weeks of amphotericin B (1 mg per kilogram per day). Each patient assigned to receive amphotericin B was also randomly assigned to receive fluconazole or flucytosine as a partner drug. After induction treatment, all the patients received fluconazole consolidation therapy and were followed to 10 weeks. Results A total of 721 patients underwent randomization. Mortality in the oral-regimen, 1-week amphotericin B, and 2-week amphotericin B groups was 18.2% (41 of 225), 21.9% (49 of 224), and 21.4% (49 of 229), respectively, at 2 weeks and was 35.1% (79 of 225), 36.2% (81 of 224), and 39.7% (91 of 229), respectively, at 10 weeks. The upper limit of the one-sided 97.5% confidence interval for the difference in 2-week mortality was 4.2 percentage points for the oral-regimen group versus the 2-week amphotericin B groups and 8.1 percentage points for the 1-week amphotericin B groups versus the 2-week amphotericin B groups, both of which were below the predefined 10-percentage-point noninferiority margin. As a partner drug with amphotericin B, flucytosine was superior to fluconazole (71 deaths [31.1%] vs. 101 deaths [45.0%]; hazard ratio for death at 10 weeks, 0.62; 95% confidence interval [CI], 0.45 to 0.84; P=0.002). One week of amphotericin B plus flucytosine was associated with the lowest 10-week mortality (24.2%; 95% CI, 16.2 to 32.1). Side effects, such as severe anemia, were more frequent with 2 weeks than with 1 week of ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | application/pdf |
| اللغة: | English |
| العلاقة: | https://openaccess.sgul.ac.uk/id/eprint/109670/1/Antifungal%20Combinations%20for%20Treatment_SM_2018.pdfTest; Molloy, SF; Kanyama, C; Heyderman, RS; Loyse, A; Kouanfack, C; Chanda, D; Mfinanaga, S; Temfack, E; Lakhi, S; Lesikari, S; et al. Molloy, SF; Kanyama, C; Heyderman, RS; Loyse, A; Kouanfack, C; Chanda, D; Mfinanaga, S; Temfack, E; Lakhi, S; Lesikari, S; Chan, AK; Stone, N; Kalata, N; Karunaharan, N; Gaskell, K; Peirse, M; Ellis, J; Chawinga, C; Lontsi, S; Ndong, J-G; Bright, P; Lupiya, D; Chen, T; Bradley, J; Adams, J; van der Horst, C; van Oosterhout, JJ; Sini, V; Mapoure, YN; Mwaba, P; Bicanic, T; Lalloo, DG; Wang, D; Hosseinipour, MC; Lortholary, O; Jaffar, S; Harrison, TS; ACTA Trial Study Team (2018) Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa. New England Journal of Medicine, 378. pp. 1004-1017. ISSN 1533-4406 https://doi.org/10.1056/NEJMoa1710922Test SGUL Authors: Molloy, Sile |
| الإتاحة: | https://doi.org/10.1056/NEJMoa1710922Test https://openaccess.sgul.ac.uk/id/eprint/109670Test/ https://openaccess.sgul.ac.uk/id/eprint/109670/1/Antifungal%20Combinations%20for%20Treatment_SM_2018.pdfTest |
| حقوق: | publisher |
| رقم الانضمام: | edsbas.D680A52C |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |