Статья

Evaluation of a standardized treatment regimen of anti-tuberculosis drugs for patients with multi-drug-resistant tuberculosis (STREAM): study protocol for a randomized controlled trial

Andrew NunnMedical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London WC2B 6NH, UK. [email protected]I. D. RusenInternational Union Against Tuberculosis and Lung Disease, 68, bd Saint-Michel, 75006, Paris, FranceArmand Van DeunInstitute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, BelgiumGabriela TorreaInstitute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, BelgiumPatrick PhillipsMedical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH, UKChen‐Yuan ChiangDivision of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, No 111, Section 3, Hsin-Long Road, Taipei City, 116, TaiwanS. Bertel SquireCentre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, 3 5QA, UKJason MadanWarwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UKSarah MeredithMedical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH, UK

2014en

ABI

Аннотация

BACKGROUND: In contrast to drug-sensitive tuberculosis, the guidelines for the treatment of multi-drug-resistant tuberculosis (MDR-TB) have a very poor evidence base; current recommendations, based on expert opinion, are that patients should be treated for a minimum of 20 months. A series of cohort studies conducted in Bangladesh identified a nine-month regimen with very promising results. There is a need to evaluate this regimen in comparison with the currently recommended regimen in a randomized controlled trial in a variety of settings, including patients with HIV-coinfection. METHODS/DESIGN: STREAM is a multi-centre randomized trial of non-inferiority design comparing a nine-month regimen to the treatment currently recommended by the World Health Organization in patients with MDR pulmonary TB with no evidence on line probe assay of fluoroquinolone or kanamycin resistance. The nine-month regimen includes clofazimine and high-dose moxifloxacin and can be extended to 11 months in the event of delay in smear conversion. The primary outcome is based on the bacteriological status of the patients at 27 months post-randomization. Based on the assumption that the nine-month regimen will be slightly more effective than the control regimen and, given a 10% margin of non-inferiority, a total of 400 patients are required to be enrolled. Health economics data are being collected on all patients in selected sites. DISCUSSION: The results from the study in Bangladesh and cohorts in progress elsewhere are encouraging, but for this regimen to be recommended more widely than in a research setting, robust evidence is needed from a randomized clinical trial. Results from the STREAM trial together with data from ongoing cohorts should provide the evidence necessary to revise current recommendations for the treatment for MDR-TB. TRIAL REGISTRATION: This trial was registered with clincaltrials.gov (registration number: ISRCTN78372190) on 14 October 2010.

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Идентификаторы

DOI: 10.1186/1745-6215-15-353

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Цитирований: 2Использованных источников: 0

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