Treatment Outcomes of Patients With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis According to Drug Susceptibility Testing to First- and Second-line Drugs: An Individual Patient Data Meta-analysis
Mayara Lisboa BastosTuberculosis Scientific League, Rio de Janeiro, BrazilHamidah HussainInteractive Research and Development, Karachi, PakistanKarin WeyerGlobal Tuberculosis Programme, World Health Organization, Geneva, SwitzerlandLourdes García‐GarcíaInstituto Nacional de Salud Pública, Cuernavaca, Morelos, MexicoVaira LeimaneChi Chiu LeungTuberculosis and Chest Service, Department of Health, Hong Kong, ChinaMasahiro NaritaDivision of Pulmonary and Critical Care, University of Washington, SeattleJosé M. PeñaInstituto Nacional de Ciencias Médicas y de Nutrición "Salvador Zubirán,"Mexico CityAlfredo Ponce‐de‐LeónBrigham and Women's Hospital, Boston, MassachusettsKwonjune J. SeungLung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, South AfricaK. SheanInstituto Nacional de Ciencias Médicas y de Nutrición "Salvador Zubirán,"Mexico CityJosé Sifuentes‐OsornioTuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, PretoriaMartie van der WaltUniversity of GroningenTjip S. van der WerfThe Chinese University of Hong Kong, ChinaWing Wai YewMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityDick MenziesRespiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, Canadafor the Collaborative Group for Meta-analysis of Individual Patient Data in MDR-TBMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityShama D. AhujaMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityDavid AshkinInfectious Diseases Service, Departments of Internal Medicine, and Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, TheNetherlandsMauricio AvendañoMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityRabin BanerjeeMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityMelissa BauerM. C. BecerraRespiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, CanadaAndrea BenedettiUniversity of GroningenM. BurgosInstituto Nacional de Ciencias Médicas y de Nutrición "Salvador Zubirán,"Mexico CityRosella CentisEdward D. ChanUniversity of GroningenChen‐Yuan ChiangLung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, South AfricaFrank CobelensTuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, PretoriaHelen CoxLia D’AmbrosioMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityWiel C.M. de LangeMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityKathryn DeRiemerRespiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, CanadaDonald A. EnarsonMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityDennis FalzonInfectious Diseases Service, Departments of Internal Medicine, and Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, TheNetherlandsKatie L. FlanaganRespiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, CanadaJennifer FloodInstituto Nacional de Salud Pública, Cuernavaca, Morelos, MexicoNeel R. GandhiL. Garcia-GarciaReuben GranichMaria-Graciela Hollm-DelgadoUniversity of GroningenTimothy H. HoltzRespiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, CanadaPhilip C. HopewellM D IsemanRespiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, CanadaLeah G. JarlsbergSalmaan KeshavjeeH. R. KimInfectious Diseases Service, Departments of Internal Medicine, and Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, TheNetherlandsWon‐Jung KohMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityJ. LancasterChristoph LangeTuberculosis and Chest Service, Department of Health, Hong Kong, ChinaV. LeimaneInfectious Diseases Service, Departments of Internal Medicine, and Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, TheNetherlandsJoanne C LiGiovanni Battista MiglioriDivision of Pulmonary and Critical Care, University of Washington, SeattleC. M. MitnickMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityEva NathansonUniversity of GroningenRonel OdendaalRespiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, CanadaPhilly O'RiordanMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityMadhukar PaiDomingo PalmeroThe Chinese University of Hong Kong, ChinaS. K. ParkServicio de Medicina Interna, Hospital Universitario La Paz, Universidad Autonoma Madrid, SpainGeoffrey PasvolMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityCarlos Pérez-GuzmánInteractive Research and Development, Karachi, PakistanM. I. D. QuelapioUniversity of GroningenHoang Thi QuyUniversity of GroningenVija RiekstiņaMcGill International Tuberculosis Centre and Department of Epidemiology, Biostatistics, and Occupational Health, McGill UniversityJ. RobertRespiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, CanadaSarah RoyceM SalimBrigham and Women's Hospital, Boston, MassachusettsH. Simon SchaafTuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, PretoriaLisa ShahK. SheanInteractive Research and Development, Karachi, PakistanTae Sun ShimThe Chinese University of Hong Kong, ChinaSteven S. ShinInstituto Nacional de Ciencias Médicas y de Nutrición "Salvador Zubirán,"Mexico CityYoshimasa ShiraishiThe Chinese University of Hong Kong, ChinaGiovanni SotgiuMatthew StrandInfectious Diseases Service, Departments of Internal Medicine, and Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, TheNetherlandsSook Whan SungInstituto Nacional de Ciencias Médicas y de Nutrición "Salvador Zubirán,"Mexico CityPayam TabarsiThelma E. TupasiInfectious Diseases Service, Departments of Internal Medicine, and Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, TheNetherlandsMario H. VargasTuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, PretoriaRichard van AltenaInfectious Diseases Service, Departments of Internal Medicine, and Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, TheNetherlandsPiret ViikleppThe Chinese University of Hong Kong, ChinaJanice WestenhouseWing Wai YewJae‐Joon Yim
2014en
Ochiq kirishYashil
ABI
Annotatsiya
BACKGROUND: Individualized treatment for multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis depends upon reliable and valid drug susceptibility testing (DST) for pyrazinamide, ethambutol, and second-line tuberculosis drugs. However, the reliability of these tests is uncertain, due to unresolved methodological issues. We estimated the association of DST results for pyrazinamide, ethambutol, and second-line drugs with treatment outcomes in patients with MDR tuberculosis and XDR tuberculosis. METHODS: We conducted an analysis of individual patient data assembled from 31 previously published cohort studies of patients with MDR and XDR tuberculosis. We used data on patients' clinical characteristics including DST results, treatment received, outcomes, and laboratory methods in each center. RESULTS: DST methods and treatment regimens used in different centers varied considerably. Among 8955 analyzed patients, in vitro susceptibility to individual drugs was consistently and significantly associated with higher odds of treatment success (compared with resistance to the drug), if that drug was used in the treatment regimen. Various adjusted and sensitivity analyses suggest that this was not explained by confounding. The adjusted odds of treatment success for ethambutol, pyrazinamide, and the group 4 drugs ranged from 1.7 to 2.3, whereas for second-line injectables and fluoroquinolones, odds ranged from 2.4 to 4.6. CONCLUSIONS: DST for ethambutol, pyrazinamide, and second-line tuberculosis drugs appears to provide clinically useful information to guide selection of treatment regimens for MDR and XDR tuberculosis.
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