Adjunctive echinocandin for HIV-negative Pneumocystis pneumonia

Note

This report is preliminary based on evalauble papers identifed.

Overview

This site presents an interim meta-analysis of adjunctive echinocandin/caspofungin plus trimethoprim-sulfamethoxazole (TMP-SMX) versus TMP-SMX monotherapy for all-cause mortality in HIV-negative / immunocompromised adults with Pneumocystis jirovecii pneumonia (PCP/PJP). It corresponds to the PROSPERO-registered review question on combination and adjunctive treatment regimens, and reports both a frequentist and a Bayesian synthesis of the same six source-verified studies.

Headline finding

Pooling the six source-verified studies, adjunctive echinocandin shows a possible but inconclusive mortality benefit versus monotherapy — the interval includes no effect under both frameworks.

Analysis Studies Pooled OR (95% interval)
Bayesian sensitivity (primary reporting) 6 0.76 (0.43–1.37)
Frequentist random-effects (REML) 6 0.75 (0.42–1.36)
Bayesian primary (in-hospital / ~30-day) 3 0.78 (0.31–1.93)

An OR below 1 favours combination therapy.

How to navigate

  • Included studies — the analytic dataset and per-study verification notes.
  • PRISMA flow — study selection for this contrast.
  • Frequentist results — REML and Mantel-Haenszel pooling, heterogeneity, funnel plot.
  • Bayesian results — posterior forest plot and marginal posteriors.
  • Model fit & MCMC — independent random-walk Metropolis refit with convergence diagnostics (R̂, ESS, trace plots).
  • Sensitivity — leave-one-out, prior sensitivity, timing subgroups.
  • Goodness of fit — fit and influence diagnostics, posterior predictive checks.
  • Risk of bias — preliminary ROBINS-I assessment.
  • Conclusions — summary and implications.

What was verified

  • Tian2020 excluded — an HIV-positive cohort that had been misclassified in the machine-draft extraction.
  • Qi2025 / Yanmeng2026 de-duplicated — the same PUMCH cohort; the full-cohort comparison (not the ventilated subgroup) was used.
  • Counts were source-checked against the original full texts for every included study.

Language / lingua

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