Efficacy and safety of echinocandins combined with Trimethoprim-Sulfamethoxazole as first-line treatment for Pneumocystis pneumonia in HIV-infected and non-HIV-infected patients
Abstract
Pneumocystis pneumonia (PCP) is a life-threatening infection in both HIV- infected and non-HIV-infected immunocompromised patients. Although Trimethoprim-Sulfamethoxazole (TMP/SMX) combined with echinocandins has been used clinically, whether this combination is superior to TMP/SMX monotherapy as first-line treatment remains inconclusive. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of TMP/SMX plus echinocandins versus TMP/SMX alone in treating PCP. The protocol of this study was registered at the PROSPERO, with registration number CRD420251008762. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for studies published before February 28, 2025. Included studies involved patients with confirmed PCP infection receiving either TMP/SMX plus echinocandins or TMP/SMX monotherapy. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included overall positive response rate and adverse events (AEs). Seven studies involving 1963 patients were included. Combination therapy was associated with significantly lower mortality in HIV-infected patients (OR = 0.44, 95% CI: 0.28–0.70, p = 0.0005), but not in non-HIV-infected patients (OR = 1.00, 95% CI: 0.57–1.76, p = 0.99). The treatment response rate was higher with combination therapy in both HIV-infected and non-HIV-infected patients (OR = 2.29, 95% CI: 1.61–3.28, p < 0.00001). The positive response rate was significantly higher in non-HIV-infected…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,963 participants or records.
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