Effectiveness of non-pyrimethamine-based regimens for toxoplasma encephalitis: A systematic and meta-synthesis study

ABSTRACT

Objective: To examine the differences in effectiveness and side effects between pyrimethamine-based and non-pyrimethaminebased regimens for toxoplasma encephalitis since the availability of pyrimethamine in Indonesia is currently limited due to its withdrawal from the market. Methods: A systematic review and meta-synthesis study that was carried out by following a protocol guided by the Preffered Reporting Items for Systematic Review and Meta-analysis (PRISMA). Effectiveness measures included clinical improvement, mortality, and radiological improvement. We evaluated selected articles narratively because of the limitations of homogeneity. The risk of bias in RCTs was assessed using the Cochrane Risk of Bias tool for RCT (ROB 2.0) and cohort studies were assessed using the Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-1) tool. Research quality was assessed using the GradePro software. Results: We included two retrospective cohort studies and one RCT. Narrative outcome assessment in these three studies did not show significant difference in effectiveness between pyrimethamine-based and non-pyrimethamine-based regimens for toxoplasma encephalitis treatment. However, drug side effects were consistently higher in the pyrimethamine-based regimen. Conclusions: This study has a high risk of bias. The quality of the research also has a low recommendation value. However, the results may be considered for application if a standard regimen is not available.