Мақола

Standardised shorter regimens <i>versus</i> individualised longer regimens for rifampin- or multidrug-resistant tuberculosis

S.K. AbidiMcGill International TB Centre, Montreal, QC, CanadaJay AcharMédecins Sans Frontières/Doctors without Borders, London, UKM.M. Assao NeinoNational Tuberculosis Program, Niamey, NigerDidi BangInternational Reference Laboratory of Mycobacteriology, National Centre for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, DenmarkAndrea BenedettiDept of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, CanadaSarah K. BrodeWest Park Healthcare Centre, University Health Network and University of Toronto, Toronto, ON, CanadaJonathon R. CampbellMcGill International TB Centre, Montreal, QC, CanadaEsther C. CasasMédecins Sans Frontières/Doctors without Borders, Amsterdam, The NetherlandsFrancesca ConradieDept of Medicine, University of Witswatersrand, Johannesburg, South AfricaGunta DravnieceKNCV TB Foundation, The Hague, The NetherlandsPhilipp du CrosBurnet Institute, Melbourne, AustraliaDennis FalzonWorld Health Organization, Geneva, SwitzerlandErnesto JaramilloWorld Health Organization, Geneva, SwitzerlandChristopher KuabanFaculty of Health Sciences, The University of Bamenda, Bambili, CameroonZhiyi LanMcGill International TB Centre, Montreal, QC, CanadaChristoph LangeDept of Medicine, Karolinska Institute, Stockholm, SwedenPei Zhi LiRespiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, CanadaMavluda MakhmudovaAung Kya Jai MaugDick MenziesMcGill International TB Centre, Montreal, QC, CanadaGiovanni Battista MiglioriWHO Collaborating Centre for Tuberculosis and Lung Diseases, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, ItalyAnn C. MillerDept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USABakyt MyrzalievKNCV TB Foundation, Branch Office KNCV in Kyrgyzstan, Bishkek, KyrgyzstanNorbert NdjekaJ NoeskeNational Tuberculosis Programme, Yaounde, CameroonNargiza ParpievaNational TB Institute, Tashkent, UzbekistanAlberto PiubelloDamien Foundation, Brussels, BelgiumV SchwoebelInternational Union Against Tuberculosis and Lung Disease, Paris, FranceWelile SikhondzeNational TB Control Program, Eswatini Ministry of Health, Mbabane, SwazilandRupak SinglaNational Institute of Tuberculosis and Respiratory Diseases, Delhi, IndiaMahamadou Bassirou SouleymaneArnaud TrébucqInternational Union Against Tuberculosis and Lung Disease, Paris, FranceArmand Van DeunMycobacteriology Unit, Institute of Tropical Medicine, Antwerp, BelgiumKerri VineyAustralian National University, Canberra, AustraliaKarin WeyerWorld Health Organization, Geneva, SwitzerlandBetty Jingxuan ZhangMcGill International TB Centre, Montreal, QC, CanadaFaiz Ahmad KhanMcGill International TB Centre, Montreal, QC, Canada [email protected]

European Respiratory Journaljournal2019en

ABI

Аннотация

We sought to compare the effectiveness of two World Health Organization (WHO)-recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis (TB): a standardised regimen of 9–12 months (the “shorter regimen”) and individualised regimens of ≥20 months (“longer regimens”). We collected individual patient data from observational studies identified through systematic reviews and a public call for data. We included patients meeting WHO eligibility criteria for the shorter regimen: not previously treated with second-line drugs, and with fluoroquinolone- and second-line injectable agent-susceptible RR/MDR-TB. We used propensity score matched, mixed effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRDs) for failure or relapse, death within 12 months of treatment initiation and loss to follow-up. We included 2625 out of 3378 (77.7%) individuals from nine studies of shorter regimens and 2717 out of 13 104 (20.7%) individuals from 53 studies of longer regimens. Treatment success was higher with the shorter regimen than with longer regimens (pooled proportions 80.0% versus 75.3%), due to less loss to follow-up with the former (aRD −0.15, 95% CI −0.17– −0.12). The risk difference for failure or relapse was slightly higher with the shorter regimen overall (aRD 0.02, 95% CI 0–0.05) and greater in magnitude with baseline resistance to pyrazinamide (aRD 0.12, 95% CI 0.07–0.16), prothionamide/ethionamide (aRD 0.07, 95% CI −0.01–0.16) or ethambutol (aRD 0.09, 95% CI 0.04–0.13). In patients meeting WHO criteria for its use, the standardised shorter regimen was associated with substantially less loss to follow-up during treatment compared with individualised longer regimens and with more failure or relapse in the presence of resistance to component medications. Our findings support the need to improve access to reliable drug susceptibility testing.

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Мавзулар

Tuberculosis Research and Epidemiology HIV/AIDS drug development and treatment Pneumocystis jirovecii pneumonia detection and treatment

Идентификаторлар

DOI: 10.1183/13993003.01467-2019

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