Meta-analysis of echinocandins combined with trimethoprim-sulfamethoxazole for treatment of Pneumocystis pneumonia

Abstract

Echinocandins form a new drug class for the treatment of Pneumocystis pneumonia (PCP), but their efficacies have not been confirmed. The objective of this study was to review the all-cause mortality and efficacy of echinocandins combined with trimethoprim/sulfamethoxazole (TMP/SMZ) for the treatment of PCP. A meta-analysis of retrospective case-control studies of echinocandins combined with TMP/SMZ or TMP/SMZ alone for treating adult PCP was performed. Pubmed, Web of Sciences, Cochrane Register of Controlled Trials, and Embase databases were searched from inception to October 20, 2021. The quality of the included studies was assessed using the Newcastle–Ottawa scale (NOS). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using a fixed effects model in the meta-analysis to derive pooled estimates of effect size. Five-hundred forty articles were identified and screened, and five studies were included meta-analysis. Echinocandins combined with TMP/SMZ led to a reduction in all-cause mortality of pneumocystis pneumonia (OR = 0.47; 95%CI 0.32-0.71; P = 0.0003), and the total positive response rate of echinocandins combined with TMP/SMZ was higher than that of TMP/SMZ (OR = 2.16; 95%CI 1.46-3.19; P = 0.0001). This meta-analysis based on retrospective case-control studies was first to show that echinocandins combined with TMP/SMZ for the treatment of pneumocystis pneumonia can lead to a reduction in mortality and improvement in treatment response rates. It is suggested that echinocandins may be a good drug for treating PCP.

Keywords:

• Echinocandins
• pneumocystis pneumonia
• trimethoprim-sulfamethoxazole
• treatment
• meta-analysis

Acknowledgments

The authors thank the organ transplant staff at the Renmin Hospital of Wuhan University for their help in preparation of this work.

Author contributions

JG and ZC are joint first authors of this article, undertook the statistical analysis, and interpreted data. TQ conceived and designed the study. JG, ZC, CK, and BY undertook the systematic literature search, acquisition of data, quality check, and risk of bias assessment. BY contributed to the design of statistical analysis. JG, ZC, CK, and BY drafted the manuscript. JZ and TQ obtained funding and supervised the study. TW, YZ, and YL provided important intellectual input. All authors approved the final version of manuscript before submission.

Data sharing statement

No unpublished data are available.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics statements

Patient consent for publication

Not required.

Consent for publication

All the authors approved of this version of the manuscript for publication.

Additional information

Funding

This project was supported by the National Natural Science Foundation of China(No. 81870067, JZ; No. 82170664, JZ) and Wuhan Science and Technology Bureau (No.2020020601012213,JZ) .