{"doi":"10.1093/cid/ciae326","title":"Comparison of Early Fungicidal Activity and Mortality Between Daily Liposomal Amphotericin B and Daily Amphotericin B Deoxycholate for Cryptococcal Meningitis","abstract":"BACKGROUND: Limited data exist on the antifungal activity of daily liposomal amphotericin B with flucytosine induction regimens for cryptococcal meningitis, which are recommended in high-income countries. Liposomal amphotericin B monotherapy at 3 mg/kg previously failed to meet noninferiority criteria compared to amphotericin B deoxycholate in its registrational clinical trial. We aimed to compare the quantitative antifungal activity and mortality between daily amphotericin B deoxycholate and daily liposomal amphotericin B among persons with human immunodeficiency virus (HIV)-related cryptococcal meningitis receiving adjunctive flucytosine 100 mg/kg/day. METHODS: We analyzed data from 3 clinical studies involving participants with HIV-associated cryptococcal meningitis receiving either daily liposomal amphotericin B at 3 mg/kg/day with flucytosine (n = 94) or amphotericin B deoxycholate at 0.7-1.0 mg/kg/day with flucytosine (n = 404) as induction therapy. We compared participant baseline characteristics, cerebrospinal fluid (CSF) early fungicidal activity (EFA), and 10-week mortality. RESULTS: We included 498 participants in this analysis, of whom 201 had available EFA data (n = 46 liposomal amphotericin B; n = 155 amphotericin B deoxycholate). Overall, there is no statistical evidence that the antifungal activity of liposomal amphotericin B (mean EFA, 0.495 [95% confidence interval {CI}, .355-.634] log10 colony-forming units [CFU]/mL/day) differ from amphotericin B deoxycholate (mean EFA, 0.402 [95% CI, .360-.445] log10 CFU/mL) (P = .13). Mortality at 10 weeks trended lower for liposomal amphotericin B (28.2%) versus amphotericin B deoxycholate (34.6%) but was not statistically different when adjusting for baseline characteristics (adjusted hazard ratio, 0.74 [95% CI, .44-1.25]; P = .26). CONCLUSIONS: Daily liposomal amphotericin B induction demonstrated a similar rate of CSF fungal clearance and 10-week mortality as amphotericin B deoxycholate when combined with flucytosine for the treatment of HIV-associated cryptococcal meningitis.","journal":"Clinical Infectious Diseases","year":2024,"id":442750,"datarank":0.35415790884695647,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.024574222246523503,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.024574222246523503,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":4,"citers_with_citation_signal":1,"citers_with_endowment":1,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9533,"is_data_producer":true,"deposit_databanks":{"ISRCTN":["ISRCTN72509687"],"ClinicalTrials.gov":["NCT04031833"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":110706,"name":"Richard Kwizera","orcid":"0000-0002-5270-3539","position":1,"is_corresponding":false},{"id":1025678,"name":"Biyue Dai","orcid":"0000-0002-4747-3687","position":2,"is_corresponding":false},{"id":1025677,"name":"Enos Kigozi","orcid":"0009-0005-4503-4719","position":3,"is_corresponding":false},{"id":1026261,"name":"Derrick Kasozi","orcid":null,"position":4,"is_corresponding":false},{"id":644485,"name":"Morris K Rutakingirwa","orcid":"0000-0003-2276-360X","position":5,"is_corresponding":false},{"id":1256506,"name":"Asmus Tukundane","orcid":"0009-0001-1444-8389","position":6,"is_corresponding":false},{"id":1256954,"name":"Nabbaale Shifah","orcid":null,"position":7,"is_corresponding":false},{"id":732099,"name":"Tony Luggya","orcid":null,"position":8,"is_corresponding":false},{"id":1256955,"name":"Andrew Luswata","orcid":null,"position":9,"is_corresponding":false},{"id":919883,"name":"Jane Francis Ndyetukira","orcid":"0009-0007-3955-8107","position":10,"is_corresponding":false},{"id":1256507,"name":"Spencer Yueh","orcid":"0009-0008-6449-3760","position":11,"is_corresponding":false},{"id":1256956,"name":"Suzan Mulwana","orcid":null,"position":12,"is_corresponding":false},{"id":1256957,"name":"Abduljewad Wele","orcid":null,"position":13,"is_corresponding":false},{"id":267769,"name":"Nathan C. Bahr","orcid":"0000-0002-9431-8938","position":14,"is_corresponding":false},{"id":397657,"name":"David B. Meya","orcid":"0000-0002-8854-0321","position":15,"is_corresponding":false},{"id":267658,"name":"David R. Boulware","orcid":"0000-0002-4715-0060","position":16,"is_corresponding":false},{"id":267647,"name":"Caleb P Skipper","orcid":"0000-0002-0000-8876","position":17,"is_corresponding":false},{"id":1025676,"name":"Sarah Kimuda","orcid":"0009-0002-1335-9787","position":0,"is_corresponding":true}],"reference_count":25,"raw_metadata":null,"created_at":"2026-07-19T02:01:20.107161Z","pmid":"38943665","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}