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dc.contributor.authorCampbell, Jeffrey I.en_US
dc.contributor.authorKanters, Steveen_US
dc.contributor.authorBennett, John E.en_US
dc.contributor.authorThorlund, Kristianen_US
dc.contributor.authorTsai, Alexander C.en_US
dc.contributor.authorMills, Edward J.en_US
dc.contributor.authorSiedner, Mark J.en_US
dc.date.accessioned2015-07-13T18:47:32Z
dc.date.issued2015en_US
dc.identifier.citationCampbell, Jeffrey I., Steve Kanters, John E. Bennett, Kristian Thorlund, Alexander C. Tsai, Edward J. Mills, and Mark J. Siedner. 2015. “Comparative Effectiveness of Induction Therapy for Human Immunodeficiency Virus-Associated Cryptococcal Meningitis: A Network Meta-Analysis.” Open Forum Infectious Diseases 2 (1): ofv010. doi:10.1093/ofid/ofv010. http://dx.doi.org/10.1093/ofid/ofv010.en
dc.identifier.issn2328-8957en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:17295725
dc.description.abstractBackground. Multiple international treatment guidelines recommend amphotericin-based combination regimens for induction therapy of cryptococcal meningitis. Yet, only 1 trial has reported a mortality benefit for combination amphotericin-flucytosine, and none have reported a mortality benefit for combination amphotericin-fluconazole. Methods. We conducted a Bayesian network meta-analysis to estimate the comparative effectiveness of recommended induction therapies for HIV-associated cryptococcal meningitis. We searched PubMed and Cochrane CENTRAL for clinical reports of induction therapy for HIV-associated cryptococcal meningitis. We extracted or calculated early (two-week) and late (six to 12-week) mortality by treatment arm for the following induction regimens: amphotericin B alone, amphotericin B + flucytosine, amphotericin B + triazoles, amphotericin B + flucytosine +triazoles, triazoles alone, triazoles + flucytosine, liposomal amphotericin B, and amphotericin B + other medicines. Results. In the overall sample (35 studies, n = 2483), we found no evidence of decreased mortality from addition of flucytosine or triazoles to amphotericin B, compared with amphotericin B alone. Although we did find a nonsignificant benefit for addition of flucytosine to amphotericin B in studies including participants with altered levels of consciousness, we did not identify a benefit for combination therapy in restricted analyses in either resource-rich or resource-limited settings, studies conducted before or after 2004, and studies restricted to a high dose of amphotericin B and fluconazole. Conclusions. Given considerations of drug availability and toxicity, there is an important need for additional data to clarify which populations are most likely to benefit from combination therapies for human immunodeficiency virus-associated cryptococcal meningitis.en
dc.language.isoen_USen
dc.publisherOxford University Pressen
dc.relation.isversionofdoi:10.1093/ofid/ofv010en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438891/pdf/en
dash.licenseLAAen_US
dc.subjectcryptococcal meningitisen
dc.subjectHIV/AIDSen
dc.subjectinduction therapyen
dc.subjectnetwork meta-analysisen
dc.subjecttherapeuticsen
dc.titleComparative Effectiveness of Induction Therapy for Human Immunodeficiency Virus-Associated Cryptococcal Meningitis: A Network Meta-Analysisen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalOpen Forum Infectious Diseasesen
dash.depositing.authorCampbell, Jeffrey I.en_US
dc.date.available2015-07-13T18:47:32Z
dc.identifier.doi10.1093/ofid/ofv010*
dash.contributor.affiliatedCampbell, Jeffrey
dash.contributor.affiliatedTsai, Alexander
dash.contributor.affiliatedSiedner, Mark


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