Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis
RCT (n=844 in 5 African countries) found single-dose liposomal amphotericin B combined with flucytosine & fluconazole noninferior to WHO-recommended treatment (at 10 weeks, deaths in 24.8% vs. 28.7%, respectively; p<0.001 noninferiority) & was linked to fewer adverse events.
Source:
New England Journal of Medicine
SPS commentary:
In the study, patients were randomised to receive either a single high dose of liposomal amphotericin B (10 mg/kg) on day 1 plus 14 days of flucytosine (100 mg/kg/day) and fluconazole (1200 mg per day) or the current WHO recommended treatment, which includes amphotericin B deoxycholate (1 mg/kg/day) plus flucytosine (100 mg/kg/day) for 7 days, followed by fluconazole (1200 mg per day) for 7 days (control).
An editorial discusses the significance of these results mean, and what this new regimen could bring to the management of cryptococcal meningitis in high-burden settings. It notes there is clear potential for this liposomal amphotericin B–based regimen to simplify management and improve outcomes of cryptococcal meningitis in high-burden settings.