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Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis.
Abidi, Syed; Achar, Jay; Assao Neino, Mourtala Mohamed; Bang, Didi; Benedetti, Andrea; Brode, Sarah; Campbell, Jonathon R; Casas, Esther C; Conradie, Francesca; Dravniece, Gunta; du Cros, Philipp; Falzon, Dennis; Jaramillo, Ernesto; Kuaban, Christopher; Lan, Zhiyi; Lange, Christoph; Li, Pei Zhi; Makhmudova, Mavluda; Maug, Aung Kya Jai; Menzies, Dick; Migliori, Giovanni Battista; Miller, Ann; Myrzaliev, Bakyt; Ndjeka, Norbert; Noeske, Jürgen; Parpieva, Nargiza; Piubello, Alberto; Schwoebel, Valérie; Sikhondze, Welile; Singla, Rupak; Souleymane, Mahamadou Bassirou; Trébucq, Arnaud; Van Deun, Armand; Viney, Kerri; Weyer, Karin; Zhang, Betty Jingxuan; Ahmad Khan, Faiz.
Afiliação
  • Abidi S; McGill International TB Centre, Montreal, QC, Canada.
  • Achar J; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
  • Assao Neino MM; Médecins Sans Frontières/Doctors without Borders, London, UK.
  • Bang D; National Tuberculosis Program, Niamey, Niger.
  • Benedetti A; International Reference Laboratory of Mycobacteriology, National Centre for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
  • Brode S; McGill International TB Centre, Montreal, QC, Canada.
  • Campbell JR; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
  • Casas EC; Dept of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.
  • Conradie F; West Park Healthcare Centre, University Health Network and University of Toronto, Toronto, ON, Canada.
  • Dravniece G; McGill International TB Centre, Montreal, QC, Canada.
  • du Cros P; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
  • Falzon D; Médecins Sans Frontières/Doctors without Borders, Amsterdam, The Netherlands.
  • Jaramillo E; Dept of Medicine, University of Witswatersrand, Johannesburg, South Africa.
  • Kuaban C; KNCV TB Foundation, The Hague, The Netherlands.
  • Lan Z; Médecins Sans Frontières/Doctors without Borders, London, UK.
  • Lange C; Burnet Institute, Melbourne, Australia.
  • Li PZ; World Health Organization, Geneva, Switzerland.
  • Makhmudova M; World Health Organization, Geneva, Switzerland.
  • Maug AKJ; Faculty of Health Sciences, The University of Bamenda, Bambili, Cameroon.
  • Menzies D; McGill International TB Centre, Montreal, QC, Canada.
  • Migliori GB; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
  • Miller A; Research Center Borstel, Leibniz Lung Center, Borstel, Germany.
  • Myrzaliev B; German Center for Infection Research Clinical TB Unit, Borstel, Germany.
  • Ndjeka N; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.
  • Noeske J; Dept of Medicine, Karolinska Institute, Stockholm, Sweden.
  • Parpieva N; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
  • Piubello A; KNCV Tajikistan, Dushanbe, Tajikistan.
  • Schwoebel V; Damien Foundation, Brussels, Belgium.
  • Sikhondze W; McGill International TB Centre, Montreal, QC, Canada.
  • Singla R; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
  • Souleymane MB; WHO Collaborating Centre for Tuberculosis and Lung Diseases, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
  • Trébucq A; Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
  • Van Deun A; KNCV TB Foundation, Branch Office KNCV in Kyrgyzstan, Bishkek, Kyrgyzstan.
  • Viney K; National TB Programme, Republic of South Africa, Pretoria, South Africa.
  • Weyer K; National Tuberculosis Programme, Yaounde, Cameroon.
  • Zhang BJ; National TB Institute, Tashkent, Uzbekistan.
  • Ahmad Khan F; Damien Foundation, Brussels, Belgium.
Eur Respir J ; 55(3)2020 03.
Article em En | MEDLINE | ID: mdl-31862767
ABSTRACT
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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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Tuberculose Resistente a Múltiplos Medicamentos / Mycobacterium tuberculosis Tipo de estudo: Observational_studies / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2020 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Tuberculose Resistente a Múltiplos Medicamentos / Mycobacterium tuberculosis Tipo de estudo: Observational_studies / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2020 Tipo de documento: Article