دورية أكاديمية
Comparative efficacy and safety of Pneumocystis jirovecii pneumonia prophylaxis regimens for people living with HIV: a systematic review and network meta-analysis of randomized controlled trials.
| العنوان: | Comparative efficacy and safety of Pneumocystis jirovecii pneumonia prophylaxis regimens for people living with HIV: a systematic review and network meta-analysis of randomized controlled trials. |
|---|---|
| المؤلفون: | Prosty C; Faculty of Medicine, McGill University, Montréal, QC, Canada. Electronic address: connor.prosty@mail.mcgill.ca., Katergi K; Faculty of Medicine, Université de Montréal, Montréal, QC, Canada., Sorin M; Faculty of Medicine, McGill University, Montréal, QC, Canada., Rjeily MB; Faculty of Medicine, McGill University, Montréal, QC, Canada., Butler-Laporte G; Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, QC, Montréal, Canada., McDonald EG; Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC, Canada; Department of Medicine, Clinical Practice Assessment Unit, McGill University Health Centre, Montréal, QC, Canada., Lee TC; Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, QC, Montréal, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC, Canada; Department of Medicine, Clinical Practice Assessment Unit, McGill University Health Centre, Montréal, QC, Canada. |
| المصدر: | Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2024 Jul; Vol. 30 (7), pp. 866-876. Date of Electronic Publication: 2024 Apr 06. |
| نوع المنشور: | Journal Article; Systematic Review; Meta-Analysis; Comparative Study; Review |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 9516420 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1469-0691 (Electronic) Linking ISSN: 1198743X NLM ISO Abbreviation: Clin Microbiol Infect Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2015- : London : Elsevier Original Publication: Paris : Decker Europe, c1995- |
| مواضيع طبية MeSH: | Pneumonia, Pneumocystis*/prevention & control , Randomized Controlled Trials as Topic* , Network Meta-Analysis* , Trimethoprim, Sulfamethoxazole Drug Combination*/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination*/administration & dosage , Trimethoprim, Sulfamethoxazole Drug Combination*/adverse effects , Pneumocystis carinii*/drug effects , HIV Infections*/complications, Humans ; AIDS-Related Opportunistic Infections/prevention & control ; AIDS-Related Opportunistic Infections/drug therapy ; Dapsone/therapeutic use ; Dapsone/adverse effects ; Dapsone/administration & dosage ; Pentamidine/therapeutic use ; Pentamidine/administration & dosage ; Pentamidine/adverse effects ; Atovaquone/therapeutic use ; Atovaquone/adverse effects ; Antifungal Agents/therapeutic use ; Antifungal Agents/administration & dosage ; Antifungal Agents/adverse effects ; Treatment Outcome |
| مستخلص: | Background: Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic infection among people living with HIV (PWH), particularly among new and untreated cases. Several regimens are available for the prophylaxis of PCP, including trimethoprim-sulfamethoxazole (TMP-SMX), dapsone-based regimens (DBRs), aerosolized pentamidine (AP), and atovaquone. Objectives: To compare the efficacy and safety of PCP prophylaxis regimens in PWH by network meta-analysis. Methods: DATA SOURCES: Embase, MEDLINE, and CENTRAL from inception to June 21, 2023. Study Eligibility Criteria: Comparative randomized controlled trials (RCTs). Participants: PWH. Interventions: Regimens for PCP prophylaxis either compared head-to-head or versus no treatment/placebo. Assessment of Risk of Bias: Cochrane risk-of-bias tool for RCTs 2. Methods of Data Synthesis: Title or abstract and full-text screening and data extraction were performed in duplicate by two independent reviewers. Data on PCP incidence, all-cause mortality, and discontinuation due to toxicity were pooled and ranked by network meta-analysis. Subgroup analyses of primary versus secondary prophylaxis, by year, and by dosage were performed. Results: A total of 26 RCTs, comprising 55 treatment arms involving 7516 PWH were included. For the prevention of PCP, TMP-SMX was ranked the most favourable agent and was superior to DBRs (risk ratio [RR] = 0.54; 95% CI, 0.36-0.83) and AP (RR = 0.53; 95% CI, 0.36-0.77). TMP-SMX was also the only agent with a mortality benefit compared with no treatment/placebo (RR = 0.79; 95% CI, 0.64-0.98). However, TMP-SMX was also ranked as the most toxic agent with a greater risk of discontinuation than DBRs (RR = 1.25; 95% CI, 1.01-1.54) and AP (7.20; 95% CI, 5.37-9.66). No significant differences in PCP prevention or mortality were detected among the other regimens. The findings remained consistent within subgroups. Conclusions: TMP-SMX is the most effective agent for PCP prophylaxis in PWH and the only agent to confer a mortality benefit; consequently, it should continue to be recommended as the first-line agent. Further studies are necessary to determine the optimal dosing of TMP-SMX to maximize efficacy and minimize toxicity. (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.) |
| فهرسة مساهمة: | Keywords: AIDS; HIV; Pneumocystis; Pneumonia; Prophylaxis |
| المشرفين على المادة: | 8064-90-2 (Trimethoprim, Sulfamethoxazole Drug Combination) 8W5C518302 (Dapsone) 673LC5J4LQ (Pentamidine) Y883P1Z2LT (Atovaquone) 0 (Antifungal Agents) |
| تواريخ الأحداث: | Date Created: 20240407 Date Completed: 20240610 Latest Revision: 20240612 |
| رمز التحديث: | 20240613 |
| DOI: | 10.1016/j.cmi.2024.03.037 |
| PMID: | 38583518 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1469-0691 |
|---|---|
| DOI: | 10.1016/j.cmi.2024.03.037 |