Pub Date : 2024-10-10DOI: 10.1016/s1473-3099(24)00507-3
Ahmed Babiker, Sarah Warner, Xiaobai Li, Emad A Chishti, Eltaib Saad, Bruce J Swihart, John P Dekker, Morgan Walker, Alexander Lawandi, Sameer S Kadri
Background
Adjunctive clindamycin use is associated with survival in invasive group A streptococcus (GAS) infections but increasing clindamycin resistance in GAS has called into question its durability for this indication. Linezolid also inhibits GAS toxin and virulence factor production, but clinical efficacy data remain sparse.
Methods
We retrospectively emulated a target multicentre, non-blinded, non-inferiority trial to assess the efficacy of adjunctive linezolid compared with clindamycin in adult inpatients with invasive GAS infection treated with a β-lactam using the PINC AI database between 2016 and 2021. Patients were eligible if they had a monomicrobial GAS culture and received adjunctive therapy within 3 days of culture either concurrently or after β-lactam initiation and completed at least 3 days of β-lactam therapy. The primary outcome was adjusted risk ratio (aRR) of in-hospital mortality assessed by overlap-weighting using propensity scores. Secondary outcomes were length of stay among survivors and Clostridium difficile infection.
Findings
Of 1095 β-lactam-treated patients with GAS, 829 (76%) received clindamycin and 266 (24%) received linezolid. In the overlap weighted cohort, the receipt of linezolid was not associated with a statistically significant different aRR of in-hospital mortality compared with clindamycin (linezolid: 9·8% [26/266] vs clindamycin: 7·0% [58/829]; aRR: 0·92 [95% CI 0·42 to 1·43]; p=0·76). The risk difference was –0·005 (95% CI –0·05 to 0·04; p=0·81) and fell within the non-inferiority margin of 0·05. The primary analysis results were consistent across important subgroups and sensitivity analyses. Among survivors, median length of stay (adjusted ratio 0·96 [95% CI 0·16 to 0·08]; p=0·47) and C difficile infection risk (aRR 1·76 [95% CI 0·37 to 1·75]; p=0·29) were not statistically significantly different between the two groups.
Interpretation
In this emulated trial of adult patients with invasive GAS infections treated with β-lactam, linezolid appeared non-inferior to clindamycin suggesting linezolid as an alternative for adjunctive antitoxin therapy.
Funding
The Intramural Research Program of the US National Institutes of Health Clinical Center and the National Institute of Allergy and Infectious Disease.
背景辅助使用克林霉素与侵袭性 A 组链球菌（GAS）感染的存活率有关，但 GAS 中克林霉素耐药性的增加使人们对其在这一适应症中的持久性产生了怀疑。方法我们利用 PINC AI 数据库，回顾性地模拟了一项目标多中心、非盲法、非劣效性试验，以评估 2016 年至 2021 年期间，在使用β-内酰胺类药物治疗侵袭性 A 组链球菌感染的成年住院患者中，与林可霉素相比，利奈唑胺辅助治疗的疗效。如果患者进行了单菌 GAS 培养，并在培养后 3 天内同时或在β-内酰胺类药物开始治疗后接受了辅助治疗，且完成了至少 3 天的β-内酰胺类药物治疗，则符合条件。主要结果是院内死亡率的调整风险比 (aRR)，采用倾向评分重叠加权法进行评估。在1095名接受过β-内酰胺治疗的GAS患者中，829人（76%）接受了克林霉素治疗，266人（24%）接受了利奈唑胺治疗。在重叠加权队列中，与克林霉素相比，接受利奈唑胺治疗与院内死亡率 aRR 的差异无统计学意义（利奈唑胺：9-8% [26/266] vs 克林霉素：7-0% [58/829]; aRR: 0-92 [95% CI 0-42 to 1-43]; p=0-76）。风险差异为-0-005（95% CI -0-05至0-04；P=0-81），在0-05的非劣效性范围内。在重要的亚组和敏感性分析中，主要分析结果是一致的。在幸存者中，两组的中位住院时间（调整比值 0-96 [95% CI 0-16 至 0-08]；P=0-47）和艰难梭菌感染风险（aRR 1-76 [95% CI 0-37 至 1-75]；P=0-29）在统计学上无显著差异。释义在这项针对使用β-内酰胺治疗的侵袭性GAS感染成人患者的模拟试验中，利奈唑胺的疗效似乎并不优于克林霉素，这表明利奈唑胺可作为辅助抗毒素治疗的替代药物。
{"title":"Adjunctive linezolid versus clindamycin for toxin inhibition in β-lactam-treated patients with invasive group A streptococcal infections in 195 US hospitals from 2016 to 2021: a retrospective cohort study with target trial emulation","authors":"Ahmed Babiker, Sarah Warner, Xiaobai Li, Emad A Chishti, Eltaib Saad, Bruce J Swihart, John P Dekker, Morgan Walker, Alexander Lawandi, Sameer S Kadri","doi":"10.1016/s1473-3099(24)00507-3","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00507-3","url":null,"abstract":"<h3>Background</h3>Adjunctive clindamycin use is associated with survival in invasive group A streptococcus (GAS) infections but increasing clindamycin resistance in GAS has called into question its durability for this indication. Linezolid also inhibits GAS toxin and virulence factor production, but clinical efficacy data remain sparse.<h3>Methods</h3>We retrospectively emulated a target multicentre, non-blinded, non-inferiority trial to assess the efficacy of adjunctive linezolid compared with clindamycin in adult inpatients with invasive GAS infection treated with a β-lactam using the PINC AI database between 2016 and 2021. Patients were eligible if they had a monomicrobial GAS culture and received adjunctive therapy within 3 days of culture either concurrently or after β-lactam initiation and completed at least 3 days of β-lactam therapy. The primary outcome was adjusted risk ratio (aRR) of in-hospital mortality assessed by overlap-weighting using propensity scores. Secondary outcomes were length of stay among survivors and <em>Clostridium difficile</em> infection.<h3>Findings</h3>Of 1095 β-lactam-treated patients with GAS, 829 (76%) received clindamycin and 266 (24%) received linezolid. In the overlap weighted cohort, the receipt of linezolid was not associated with a statistically significant different aRR of in-hospital mortality compared with clindamycin (linezolid: 9·8% [26/266] <em>vs</em> clindamycin: 7·0% [58/829]; aRR: 0·92 [95% CI 0·42 to 1·43]; p=0·76). The risk difference was –0·005 (95% CI –0·05 to 0·04; p=0·81) and fell within the non-inferiority margin of 0·05. The primary analysis results were consistent across important subgroups and sensitivity analyses. Among survivors, median length of stay (adjusted ratio 0·96 [95% CI 0·16 to 0·08]; p=0·47) and <em>C difficile</em> infection risk (aRR 1·76 [95% CI 0·37 to 1·75]; p=0·29) were not statistically significantly different between the two groups.<h3>Interpretation</h3>In this emulated trial of adult patients with invasive GAS infections treated with β-lactam, linezolid appeared non-inferior to clindamycin suggesting linezolid as an alternative for adjunctive antitoxin therapy.<h3>Funding</h3>The Intramural Research Program of the US National Institutes of Health Clinical Center and the National Institute of Allergy and Infectious Disease.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"6 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142398491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1016/s1473-3099(24)00561-9
Emily L Heil, Erin K McCreary
No Abstract
无摘要
{"title":"REVISITing treatment of metallo-β-lactamases","authors":"Emily L Heil, Erin K McCreary","doi":"10.1016/s1473-3099(24)00561-9","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00561-9","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"17 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1016/s1473-3099(24)00499-7
Yehuda Carmeli, José Miguel Cisneros, Mical Paul, George L Daikos, Minggui Wang, Julian Torre-Cisneros, George Singer, Ivan Titov, Illia Gumenchuk, Yongjie Zhao, Rosa-María Jiménez-Rodríguez, Lu Liang, Gang Chen, Oleksandr Pyptiuk, Firdevs Aksoy, Halley Rogers, Michele Wible, Francis F Arhin, Alison Luckey, Joanne L Leaney, Surbhi Malhotra-Kumar
<h3>Background</h3>There is a need for additional therapeutic options for serious infections caused by Gram-negative pathogens. In the phase 3, descriptive REVISIT study, we investigated the safety and efficacy of aztreonam–avibactam in the treatment of complicated intra-abdominal infections or hospital-acquired pneumonia or ventilator-associated pneumonia (HAP–VAP) caused, or suspected to be caused, by Gram-negative bacteria.<h3>Methods</h3>This prospective, multinational, open-label, central assessor-masked study enrolled adults who were hospitalised with a complicated intra-abdominal infection or HAP–VAP. Patients were randomly allocated via block randomisation using interactive response technology stratified by infection type in a 2:1 ratio to aztreonam–avibactam (with metronidazole for complicated intra-abdominal infection) or meropenem with or without colistin for 5–14 days for complicated intra-abdominal infection or 7–14 days for HAP–VAP. The primary endpoint was clinical cure at the test-of-cure visit (within 3 days before or after day 28) in the intention-to-treat (ITT) population. Secondary endpoints included 28-day mortality in the ITT population and safety in patients in the ITT population who received study drug (safety analysis set). No formal hypothesis testing was planned. The study was registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span> (<span><span>NCT03329092</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>) and EudraCT (2017–002742–68) and is complete.<h3>Findings</h3>Between April 5, 2018, and Feb 23, 2023, we screened 461 patients. 422 patients were enrolled and randomly allocated (282 in the aztreonam–avibactam group and 140 in the meropenem group, forming the ITT analysis set), of whom ten patients (seven in the aztreonam–avibactam group and three in the meropenem group) were randomly allocated but did not receive study treatment. 271 (64%) of 422 patients had at least one Gram-negative pathogen from an adequate specimen identified at baseline. The most frequent baseline pathogens were Enterobacterales (252 [93%] of 271). Overall, 19 (24%) of 80 isolates tested for carbapenemases were carbapenemase-positive (serine, metallo-β-lactamase, or both). 193 (68·4%) of 282 patients in the aztreonam–avibactam group and 92 (65·7%) of 140 in the meropenem group had clinical cure at the test-of-cure visit (treatment difference 2·7% [95% CI –6·6 to 12·4]). For patients with complicated intra-abdominal infection, the adjudicated clinical cure rate was 76·4% (159 of 208) for the aztreonam–avibactam group and 74·0% (77 of 104) for the meropenem group. Cure rates in patients
{"title":"Aztreonam–avibactam versus meropenem for the treatment of serious infections caused by Gram-negative bacteria (REVISIT): a descriptive, multinational, open-label, phase 3, randomised trial","authors":"Yehuda Carmeli, José Miguel Cisneros, Mical Paul, George L Daikos, Minggui Wang, Julian Torre-Cisneros, George Singer, Ivan Titov, Illia Gumenchuk, Yongjie Zhao, Rosa-María Jiménez-Rodríguez, Lu Liang, Gang Chen, Oleksandr Pyptiuk, Firdevs Aksoy, Halley Rogers, Michele Wible, Francis F Arhin, Alison Luckey, Joanne L Leaney, Surbhi Malhotra-Kumar","doi":"10.1016/s1473-3099(24)00499-7","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00499-7","url":null,"abstract":"<h3>Background</h3>There is a need for additional therapeutic options for serious infections caused by Gram-negative pathogens. In the phase 3, descriptive REVISIT study, we investigated the safety and efficacy of aztreonam–avibactam in the treatment of complicated intra-abdominal infections or hospital-acquired pneumonia or ventilator-associated pneumonia (HAP–VAP) caused, or suspected to be caused, by Gram-negative bacteria.<h3>Methods</h3>This prospective, multinational, open-label, central assessor-masked study enrolled adults who were hospitalised with a complicated intra-abdominal infection or HAP–VAP. Patients were randomly allocated via block randomisation using interactive response technology stratified by infection type in a 2:1 ratio to aztreonam–avibactam (with metronidazole for complicated intra-abdominal infection) or meropenem with or without colistin for 5–14 days for complicated intra-abdominal infection or 7–14 days for HAP–VAP. The primary endpoint was clinical cure at the test-of-cure visit (within 3 days before or after day 28) in the intention-to-treat (ITT) population. Secondary endpoints included 28-day mortality in the ITT population and safety in patients in the ITT population who received study drug (safety analysis set). No formal hypothesis testing was planned. The study was registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT03329092</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>) and EudraCT (2017–002742–68) and is complete.<h3>Findings</h3>Between April 5, 2018, and Feb 23, 2023, we screened 461 patients. 422 patients were enrolled and randomly allocated (282 in the aztreonam–avibactam group and 140 in the meropenem group, forming the ITT analysis set), of whom ten patients (seven in the aztreonam–avibactam group and three in the meropenem group) were randomly allocated but did not receive study treatment. 271 (64%) of 422 patients had at least one Gram-negative pathogen from an adequate specimen identified at baseline. The most frequent baseline pathogens were Enterobacterales (252 [93%] of 271). Overall, 19 (24%) of 80 isolates tested for carbapenemases were carbapenemase-positive (serine, metallo-β-lactamase, or both). 193 (68·4%) of 282 patients in the aztreonam–avibactam group and 92 (65·7%) of 140 in the meropenem group had clinical cure at the test-of-cure visit (treatment difference 2·7% [95% CI –6·6 to 12·4]). For patients with complicated intra-abdominal infection, the adjudicated clinical cure rate was 76·4% (159 of 208) for the aztreonam–avibactam group and 74·0% (77 of 104) for the meropenem group. Cure rates in patients ","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"7 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1016/s1473-3099(24)00423-7
Matthijs P Raadsen, Christine Dahlke, Anahita Fathi, Svenja Hardtke, Michael Klüver, Verena Krähling, Gesche K Gerresheim, Leonie Mayer, Anna Z Mykytyn, Leonie M Weskamm, Tamara Zoran, Eric C M van Gorp, Gerd Sutter, Stephan Becker, Bart L Haagmans, Marylyn M Addo
<h3>Background</h3>MERS-CoV is a respiratory pathogen with a case-fatality rate of 36%, and for which no vaccines are currently licensed. MVA-MERS-S is a candidate vaccine based on recombinant modified vaccinia virus Ankara (MVA). In this study, the safety, immunogenicity, and optimal dose schedule of MVA-MERS-S was assessed in individuals with previous exposure to SARS-CoV-2 infections and vaccines.<h3>Methods</h3>We conducted a multicentre, double-blind, randomised controlled phase 1b clinical trial at two university medical centres in Germany and the Netherlands. Healthy volunteers aged 18–55 years were assigned by computer randomisation to receive three intramuscular injections of 10<sup>7</sup> or 10<sup>8</sup> plaque-forming units (PFU) of MVA-MERS-S, with two treatment groups each of either 28-day or 56-day intervals between the initial two doses, and one control arm that received only placebo, at a ratio of 2:2:2:2:1. The third dose was given after 224 days. The sponsor, clinical and laboratory staff, and participants were masked to both vaccine dose and dosing interval. The primary outcome was safety, assessed in the all participants who had received at least one injection; daily solicited vaccine reactions were recorded after each dose for 7 days, unsolicited adverse events for 28 days, and serious adverse events throughout the study. The secondary outcome was humoral immunogenicity, measured with vaccine-induced geometric mean antibody concentrations and seroconversion rates, analysed in all participants who received at least three allocated treatments. This study is registered at <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span> (<span><span>NCT04119440</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>) and is completed.<h3>Findings</h3>Between 26 July, 2021, and 3 March, 2022, 244 volunteers were screened, 177 of whom were eligible and 140 were randomly assigned either to the 28-day 10<sup>7</sup> PFU group (n=32), 56-day 10<sup>7</sup> PFU group (n=31), 28-day 10<sup>8</sup> PFU group (n=31), 56-day 10<sup>8</sup> PFU group (n=30), or placebo group (n=16). In total, 178 doses were administered of 10<sup>7</sup> PFU of MVA-MERS-S, 174 of 10<sup>8</sup> PFU, and 164 doses of placebo, and 139 participants received at least one injection. 73 (53%) were female and 66 (48%) were male. No serious vaccine-related adverse events occurred. Solicited local reactions were mild in 288 (93%, 95% CI 90–96) of 309 reports and consisted primarily of pain or tenderness. Pain or tenderness (of any severity) occurred after 69 (39%, 32–46) of 178 10<sup>7</sup> PFU injections, 138 (79%; 73–85) of 174 10<
{"title":"Safety, immunogenicity, and optimal dosing of a modified vaccinia Ankara-based vaccine against MERS-CoV in healthy adults: a phase 1b, double-blind, randomised placebo-controlled clinical trial","authors":"Matthijs P Raadsen, Christine Dahlke, Anahita Fathi, Svenja Hardtke, Michael Klüver, Verena Krähling, Gesche K Gerresheim, Leonie Mayer, Anna Z Mykytyn, Leonie M Weskamm, Tamara Zoran, Eric C M van Gorp, Gerd Sutter, Stephan Becker, Bart L Haagmans, Marylyn M Addo","doi":"10.1016/s1473-3099(24)00423-7","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00423-7","url":null,"abstract":"<h3>Background</h3>MERS-CoV is a respiratory pathogen with a case-fatality rate of 36%, and for which no vaccines are currently licensed. MVA-MERS-S is a candidate vaccine based on recombinant modified vaccinia virus Ankara (MVA). In this study, the safety, immunogenicity, and optimal dose schedule of MVA-MERS-S was assessed in individuals with previous exposure to SARS-CoV-2 infections and vaccines.<h3>Methods</h3>We conducted a multicentre, double-blind, randomised controlled phase 1b clinical trial at two university medical centres in Germany and the Netherlands. Healthy volunteers aged 18–55 years were assigned by computer randomisation to receive three intramuscular injections of 10<sup>7</sup> or 10<sup>8</sup> plaque-forming units (PFU) of MVA-MERS-S, with two treatment groups each of either 28-day or 56-day intervals between the initial two doses, and one control arm that received only placebo, at a ratio of 2:2:2:2:1. The third dose was given after 224 days. The sponsor, clinical and laboratory staff, and participants were masked to both vaccine dose and dosing interval. The primary outcome was safety, assessed in the all participants who had received at least one injection; daily solicited vaccine reactions were recorded after each dose for 7 days, unsolicited adverse events for 28 days, and serious adverse events throughout the study. The secondary outcome was humoral immunogenicity, measured with vaccine-induced geometric mean antibody concentrations and seroconversion rates, analysed in all participants who received at least three allocated treatments. This study is registered at <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT04119440</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>) and is completed.<h3>Findings</h3>Between 26 July, 2021, and 3 March, 2022, 244 volunteers were screened, 177 of whom were eligible and 140 were randomly assigned either to the 28-day 10<sup>7</sup> PFU group (n=32), 56-day 10<sup>7</sup> PFU group (n=31), 28-day 10<sup>8</sup> PFU group (n=31), 56-day 10<sup>8</sup> PFU group (n=30), or placebo group (n=16). In total, 178 doses were administered of 10<sup>7</sup> PFU of MVA-MERS-S, 174 of 10<sup>8</sup> PFU, and 164 doses of placebo, and 139 participants received at least one injection. 73 (53%) were female and 66 (48%) were male. No serious vaccine-related adverse events occurred. Solicited local reactions were mild in 288 (93%, 95% CI 90–96) of 309 reports and consisted primarily of pain or tenderness. Pain or tenderness (of any severity) occurred after 69 (39%, 32–46) of 178 10<sup>7</sup> PFU injections, 138 (79%; 73–85) of 174 10<","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"56 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1016/s1473-3099(24)00453-5
Sarah A Batawi, Basem M Alraddadi
No Abstract
无摘要
{"title":"Revisiting MERS-CoV vaccination in the SARS-CoV-2 era","authors":"Sarah A Batawi, Basem M Alraddadi","doi":"10.1016/s1473-3099(24)00453-5","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00453-5","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"6 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1016/s1473-3099(24)00581-4
Andreas K Lindner, Veerle Lejon, Michael P Barrett, Lucille Blumberg, Salome A Bukachi, Rebecca J Chancey, Andrew Edielu, Lucas Matemba, Tihitina Mesha, Victor Mwanakasale, Christopher Pasi, Tapunda Phiri, Jorge Seixas, Elie A Akl, Katrin Probyn, Gemma Villanueva, Pere P Simarro, Augustin Kadima Ebeja, Jose R Franco, Gerardo Priotto
Human African trypanosomiasis is a neglected tropical disease that is usually fatal without treatment. WHO has revised its rhodesiense human African trypanosomiasis treatment guidelines on the basis of an independent systematic literature review and following the GRADE methodology. This Review reports on the decision-making process and summarises the new recommendations and their potential implications for health-care professionals and policy makers. Due to data scarcity, all recommendations are conditional and based on very low certainty of evidence. Fexinidazole replaces suramin and melarsoprol as the first-line therapy in individuals aged 6 years and older with a bodyweight of 20 kg or more. As fexinidazole is effective in both stages of rhodesiense human African trypanosomiasis, a lumbar puncture for staging is no longer required. In settings in which first-choice drugs are not readily available, immediate interim treatment with pentamidine is suggested. The introduction of oral fexinidazole represents an advancement in the management of rhodesiense human African trypanosomiasis considering the life-threatening adverse reactions individuals can have to melarsoprol. However, children below the age or weight limits remain ineligible for treatment with fexinidazole.
{"title":"New WHO guidelines for treating rhodesiense human African trypanosomiasis: expanded indications for fexinidazole and pentamidine","authors":"Andreas K Lindner, Veerle Lejon, Michael P Barrett, Lucille Blumberg, Salome A Bukachi, Rebecca J Chancey, Andrew Edielu, Lucas Matemba, Tihitina Mesha, Victor Mwanakasale, Christopher Pasi, Tapunda Phiri, Jorge Seixas, Elie A Akl, Katrin Probyn, Gemma Villanueva, Pere P Simarro, Augustin Kadima Ebeja, Jose R Franco, Gerardo Priotto","doi":"10.1016/s1473-3099(24)00581-4","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00581-4","url":null,"abstract":"Human African trypanosomiasis is a neglected tropical disease that is usually fatal without treatment. WHO has revised its rhodesiense human African trypanosomiasis treatment guidelines on the basis of an independent systematic literature review and following the GRADE methodology. This Review reports on the decision-making process and summarises the new recommendations and their potential implications for health-care professionals and policy makers. Due to data scarcity, all recommendations are conditional and based on very low certainty of evidence. Fexinidazole replaces suramin and melarsoprol as the first-line therapy in individuals aged 6 years and older with a bodyweight of 20 kg or more. As fexinidazole is effective in both stages of rhodesiense human African trypanosomiasis, a lumbar puncture for staging is no longer required. In settings in which first-choice drugs are not readily available, immediate interim treatment with pentamidine is suggested. The introduction of oral fexinidazole represents an advancement in the management of rhodesiense human African trypanosomiasis considering the life-threatening adverse reactions individuals can have to melarsoprol. However, children below the age or weight limits remain ineligible for treatment with fexinidazole.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"66 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1016/s1473-3099(24)00671-6
Hsu Y-C, Chen C-Y, Chang I-W, et al. Once-daily tenofovir disoproxil fumarate in treatment-naive Taiwanese patients with chronic hepatitis B and minimally raised alanine aminotransferase (TORCH-B): a multicentre, double-blind, placebo-controlled, parallel-group, randomised trial. Lancet Infect Dis 2021; 21: 823–33—In this Article, I-Wei Chang's affiliation has been corrected. This correction has been made as of Oct 7, 2024.
{"title":"Correction to Lancet Infect Dis 2021; 21: 823–33","authors":"","doi":"10.1016/s1473-3099(24)00671-6","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00671-6","url":null,"abstract":"<em>Hsu Y-C, Chen C-Y, Chang I-W, et al. Once-daily tenofovir disoproxil fumarate in treatment-naive Taiwanese patients with chronic hepatitis B and minimally raised alanine aminotransferase (TORCH-B): a multicentre, double-blind, placebo-controlled, parallel-group, randomised trial.</em> Lancet Infect Dis <em>2021;</em> 21: <em>823–33</em>—In this Article, I-Wei Chang's affiliation has been corrected. This correction has been made as of Oct 7, 2024.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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