PMID- 33765022
OWN - NLM
STAT- MEDLINE
DCOM- 20211011
LR  - 20211011
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 16
IP  - 3
DP  - 2021
TI  - Efficacy and safety of trimethoprim-sulfamethoxazole for the prevention of 
      pneumocystis pneumonia in human immunodeficiency virus-negative immunodeficient 
      patients: A systematic review and meta-analysis.
PG  - e0248524
LID - 10.1371/journal.pone.0248524 [doi]
LID - e0248524
AB  - BACKGROUND: Pneumocystis pneumonia (PCP) has a significant impact on the 
      mortality of immunocompromised patients. It is not known whether the prophylactic 
      application of trimethoprim-sulfamethoxazole (TMP-SMZ) can reduce the incidence 
      of PCP and mortality in the human immunodeficiency virus (HIV)-negative 
      immunodeficient population. The safety profile is also unknown. There have been 
      few reports on this topic. The aim of this study was to systematically evaluate 
      the efficacy and safety of the use of TMP-SMZ for the prevention of PCP in this 
      population of patients from the perspective of evidence-based medicine. METHODS: 
      A comprehensive search without restrictions on publication status or other 
      parameters was conducted. Clinical randomized controlled trials (RCTs) or 
      case-control trials (CCSs) of TMP-SMZ used for the prevention of PCP in 
      HIV-negative immunocompromised populations were considered eligible. A 
      meta-analysis was performed using the Mantel-Haenszel fixed-effects model or 
      Mantel-Haenszel random-effects model, and odds ratios (ORs) with 95% confidence 
      intervals (CIs) were calculated and reported. RESULTS: Of the 2392 records 
      identified, 19 studies (n = 4135 patients) were included. The efficacy analysis 
      results indicated that the PCP incidence was lower in the TMP-SMZ group than in 
      the control group (OR = 0.27, 95% CI (0.10, 0.77), p = 0.01); however, the rate 
      of drug discontinuation was higher in the TMP-SMZ group than in the control group 
      (OR = 14.31, 95% CI (4.78, 42.91), p<0.00001). In addition, there was no 
      statistically significant difference in the rate of mortality between the two 
      groups (OR = 0.54, 95% CI (0.21, 1.37), p = 0.19). The safety analysis results 
      showed that the rate of adverse events (AEs) was higher in the TMP-SMZ group than 
      in the control group (OR = 1.92, 95% CI (1.06, 3.47), p = 0.03). CONCLUSIONS: 
      TMP-SMZ has a better effect than other drugs or the placebo with regard to 
      preventing PCP in HIV-negative immunocompromised individuals, but it may not 
      necessarily reduce the rate of mortality, the rate of drug discontinuation or 
      AEs. Due to the limitations of the research methodologies used, additional 
      large-scale clinical trials and well-designed research studies are needed to 
      identify more effective therapies for the prevention of PCP.
FAU - Li, Rui
AU  - Li R
AD  - Department of Pharmacy, The Affiliated Hospital of North Sichuan Medical College, 
      Sichuan, Nanchong, China.
FAU - Tang, Zhiyong
AU  - Tang Z
AD  - Department of Pharmacy, Nanchong Central Hospital, The Second Affiliated Clinical 
      Medical College of North Sichuan Medical College, Sichuan, Nanchong, China.
AD  - Nanchong Key Laboratory of Individualized Drug Therapy, Sichuan, Nanchong, China.
FAU - Liu, Fu
AU  - Liu F
AD  - Department of Pharmacy, The Affiliated Hospital of North Sichuan Medical College, 
      Sichuan, Nanchong, China.
FAU - Yang, Ming
AU  - Yang M
AUID- ORCID: 0000-0001-8350-6506
AD  - Department of Pharmacy, The Affiliated Hospital of North Sichuan Medical College, 
      Sichuan, Nanchong, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20210325
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 8064-90-2 (Trimethoprim, Sulfamethoxazole Drug Combination)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Child, Preschool
MH  - Clinical Trials as Topic
MH  - Female
MH  - Humans
MH  - Immunologic Deficiency Syndromes/*drug therapy
MH  - Male
MH  - Middle Aged
MH  - Pneumonia, Pneumocystis/*drug therapy
MH  - Treatment Outcome
MH  - Trimethoprim, Sulfamethoxazole Drug Combination/*administration & dosage
PMC - PMC7993619
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/03/26 06:00
MHDA- 2021/10/12 06:00
PMCR- 2021/03/25
CRDT- 2021/03/25 17:25
PHST- 2020/09/28 00:00 [received]
PHST- 2021/02/27 00:00 [accepted]
PHST- 2021/03/25 17:25 [entrez]
PHST- 2021/03/26 06:00 [pubmed]
PHST- 2021/10/12 06:00 [medline]
PHST- 2021/03/25 00:00 [pmc-release]
AID - PONE-D-20-30249 [pii]
AID - 10.1371/journal.pone.0248524 [doi]
PST - epublish
SO  - PLoS One. 2021 Mar 25;16(3):e0248524. doi: 10.1371/journal.pone.0248524. 
      eCollection 2021.