New England Journal of Medicine: Combination antifungal therapy for cryptococcal meningitis

News article 4 Apr 2013

LSTM’s Dean and professor David Lalloo is co-senior author of an influential study on combination antifungal therapy for cryptococcal meningitis, which has been published in this week’s edition of the New England Journal of Medicine. The study, led by Jeremy Day PhD of Oxford University Clinical Research Unit and theWellcome Trust Major Overseas Programme Vietnam, is the first demonstration that a combination of amphotericin B with flucytosine leads to improved survival rates among patients with cryptococcal meningitis.

The outcome is based on a randomised, three-group open-label trial of induction therapy for cryptococcal meningitis in patients with HIV infection. A total of 299 patients were enrolled, divided into 3 groups receiving different treatment regimens. The trial showed that fewer deaths occurred among patients receiving amphotericin B and flucytosine than among those receiving amphotericin B alone or with fluconazole.

The  importance of the study’s outcome is highlighted in an accompanying editorial in the Journal reflecting on the significance of the study and its impact on the management of cryptococossis, one of the most common invasive fungal infections in HIV positive patients that is estimated to cause over 600,000 deaths worldwide each year.