Reply to Oude Lashof and Vogelaers.

TO THE EDITOR—We thank Drs Oude Lashof and Vogelaers for their constructive comments regarding our analyses [1, 2]. The datasets were obtained from the authors or sponsors of the primary studies and the merged dataset was constructed based on the a priori specified primary outcome. To avoid double counting, the sequential treatment arm was considered in the amphotericin therapy group. Although we agree with the author that maximizing the data in each dataset would have been ideal, we were constrained by variation in the data provided to us with regard to choice of variables, collection, and reporting. Given that our results are consistent with the individual study results from the included studies, it is unlikely that a slightly larger sample sizewouldmaterially change the findings. Our recommendations regarding initial use of an echinocandin stem from our results. However, we do not suggest that echinocandins need to be continued for the entire duration of therapy. Oude Lashof and Vogelaers further state that echinocandin therapy will induce a significant financial burden on the healthcare system. While our study did not include a pharmacoeconomic analysis, we agree that use of an alternative to echinocandins will result in more death, which is often less expensive to the healthcare system. However, we think it is likely that a broader analysis that includes the impact of longer life and productivity to society would favor use of this drug class for invasive candidiasis.