Mycopathologia · 2026
Comparison of the Efficacy and Safety of Different Antifungal Regimen Combinations in Non-HIV and Non-transplant Cryptococcal Meningitis Patients with High Cryptococcal Count.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Liu Junyu, Li Dongcheng, Liu Jia, Lu Yaxin, Liang Jiayin, Su Xiaohong, Li Zheqi, Liu Zifeng, Jiang Ying, Peng Fuhua
Аннотация
AIM: To evaluate the efficacy and safety of four antifungal regimens in treating non-HIV and non-transplant (NHNT) cryptococcal meningitis (CM) patients with high cryptococcal count (≥ 10,000/ml).
METHODS: A retrospective analysis was conducted on 135 NHNT CM patients with high cryptococcal count who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2008 to 2023. Patients were categorized into four groups based on the antifungal regimen used during the induction period (Group1: Amphotericin B-deoxycholate (AmB-d) + 5-flucytosine (5-FC) + Voriconazole (VOR); Group2: AmB-d + 5-FC + Fluconazole (FLU); Group3: AmB-d + 5-FC; Group4: 5-FC + FLU). Treatment outcomes were assessed by comparing responses at 10 weeks.
RESULTS: Baseline characteristics were comparable across the four groups. After 2 weeks of follow-up, the positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) of Group1 (1/30; 3.3%) was significantly lower (p < 0.05) than that of Group2 and Group4 (Group2: 11/45; 24.4%; Group4: 22/43; 51.2%); the frequency of anemia in Group1(24/30; 80.0%) was significantly higher (p < 0.05) than that of Group3 and Group4 (Group3: 6/15; 40.0%; Group4: 20/43; 46.5%); and the frequency of renal impairment in Group1 (20/30; 66.7%) was significantly higher (p < 0.05) than that of Group2 and Group4 (Group2: 16/45; 35.6%; Group4: 4/43; 9.3%). Multivariate analysis showed significant associations between treatment groups and the 10-week unsuccessful outcome, with Group 1 having the lowest odds ratio (OR 0.04, 95% CI 0.01-0.22, p < 0.001) when compared to the reference group (Group 3, AmB-d + 5-FC).
CONCLUSIONS: Our observations suggested potential benefits of the AmB-d + 5-FC + VOR regimen over AmB-d + 5-FC and 5-FC + FLU for NHNT CM patients. However, clinicians must closely monitor potential side effects, particularly anemia and renal impairment, associated with this regimen.
METHODS: A retrospective analysis was conducted on 135 NHNT CM patients with high cryptococcal count who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2008 to 2023. Patients were categorized into four groups based on the antifungal regimen used during the induction period (Group1: Amphotericin B-deoxycholate (AmB-d) + 5-flucytosine (5-FC) + Voriconazole (VOR); Group2: AmB-d + 5-FC + Fluconazole (FLU); Group3: AmB-d + 5-FC; Group4: 5-FC + FLU). Treatment outcomes were assessed by comparing responses at 10 weeks.
RESULTS: Baseline characteristics were comparable across the four groups. After 2 weeks of follow-up, the positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) of Group1 (1/30; 3.3%) was significantly lower (p < 0.05) than that of Group2 and Group4 (Group2: 11/45; 24.4%; Group4: 22/43; 51.2%); the frequency of anemia in Group1(24/30; 80.0%) was significantly higher (p < 0.05) than that of Group3 and Group4 (Group3: 6/15; 40.0%; Group4: 20/43; 46.5%); and the frequency of renal impairment in Group1 (20/30; 66.7%) was significantly higher (p < 0.05) than that of Group2 and Group4 (Group2: 16/45; 35.6%; Group4: 4/43; 9.3%). Multivariate analysis showed significant associations between treatment groups and the 10-week unsuccessful outcome, with Group 1 having the lowest odds ratio (OR 0.04, 95% CI 0.01-0.22, p < 0.001) when compared to the reference group (Group 3, AmB-d + 5-FC).
CONCLUSIONS: Our observations suggested potential benefits of the AmB-d + 5-FC + VOR regimen over AmB-d + 5-FC and 5-FC + FLU for NHNT CM patients. However, clinicians must closely monitor potential side effects, particularly anemia and renal impairment, associated with this regimen.