Outcomes of WHO-conforming, longer, all-oral multidrug-resistant TB regimens and analysis implications.
| Title: | Outcomes of WHO-conforming, longer, all-oral multidrug-resistant TB regimens and analysis implications. |
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| Authors: | Rich ML; Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, Partners In Health, Boston, MA, USA.; Khan U; Interactive Research & Development Global, Singapore, Singapore.; Zeng C; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.; LaHood A; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.; Franke MF; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.; Atwood S; Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA.; Bastard M; Epicentre, Paris, France.; Burhan E; Persahabatan General Hospital, Jakarta, Indonesia.; Danielyan N; Médecins Sans Frontières (MSF), Tbilisi, Georgia.; Dzhazibekova PM; National Science Center, Almaty, Republic of Kazakhstan.; Gadissa D; Partners In Health (PIH), Addis Ababa, Ethiopia.; Ghafoor A; National Tuberculosis Programme (NTP), Ministry of National Health, Islamabad, Pakistan.; Hewison C; MSF, Paris, France.; Islam MS; Interactive Research & Development, Dhaka, Bangladesh.; Kazmi E; Directorate General Health Services, Centers for Disease Control and Prevention, Sindh, Pakistan.; Khan PY; Partners In Health, Boston, MA, USA, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.; Lecca L; Socios En Salud Sucursal, Lima, Peru.; Maama LB; PIH, Maseru, Lesotho, NTP, Maseru, Lesotho.; Melikyan N; Epicentre, Paris, France, MSF, Yerevan, Armenia.; Naing YY; MSF, Yangon, Myanmar.; Philippe K; Zanmi Lasante, Cange, Haiti.; Saki NA; World Health Organization, Country Office, Dhaka, Bangladesh.; Seung KJ; Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, Partners In Health, Boston, MA, USA.; Skrahina A; MSF, Minsk, Belarus.; Tefera GB; Partners In Health (PIH), Addis Ababa, Ethiopia.; Varaine F; MSF, Paris, France.; Vilbrun SC; GHESKIO Institute of Infectious Diseases and Reproductive Health, NTP, Port-au-Prince, Haiti.; Võ L; Friends for International TB Relief, Ho Chi Minh City, Vietnam.; Mitnick CD; Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, Partners In Health, Boston, MA, USA, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.; Huerga H; Epicentre, Paris, France. |
| Source: | The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease [Int J Tuberc Lung Dis] 2023 Jun 01; Vol. 27 (6), pp. 451-457. |
| Publication Type: | Observational Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: International Union against Tuberculosis and Lung Disease Country of Publication: France NLM ID: 9706389 Publication Model: Print Cited Medium: Internet ISSN: 1815-7920 (Electronic) Linking ISSN: 10273719 NLM ISO Abbreviation: Int J Tuberc Lung Dis Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Paris, France : International Union against Tuberculosis and Lung Disease, c1997- |
| MeSH Terms: | Antitubercular Agents*/therapeutic use ; Tuberculosis, Multidrug-Resistant*/drug therapy; Rifampin/therapeutic use ; Humans ; Drug Therapy, Combination ; Treatment Outcome ; World Health Organization |
| Abstract: | BACKGROUND: Evidence of the effectiveness of the WHO-recommended design of longer individualized regimens for multidrug- or rifampicin-resistant TB (MDR/RR-TB) is limited.OBJECTIVES: To report end-of-treatment outcomes for MDR/RR-TB patients from a 2015-2018 multi-country cohort that received a regimen consistent with current 2022 WHO updated recommendations and describe the complexities of comparing regimens.METHODS: We analyzed a subset of participants from the endTB Observational Study who initiated a longer MDR/RR-TB regimen that was consistent with subsequent 2022 WHO guidance on regimen design for longer treatments. We excluded individuals who received an injectable agent or who received fewer than four likely effective drugs.RESULTS: Of the 759 participants analyzed, 607 (80.0%, 95% CI 77.0-82.7) experienced successful end-of-treatment outcomes. The frequency of success was high across groups, whether stratified on number of Group A drugs or fluoroquinolone resistance, and ranged from 72.1% to 90.0%. Regimens were highly variable regarding composition and the duration of individual drugs.CONCLUSIONS: Longer, all-oral, individualized regimens that were consistent with 2022 WHO guidance on regimen design had high frequencies of treatment success. Heterogeneous regimen compositions and drug durations precluded meaningful comparisons. Future research should examine which combinations of drugs maximize safety/tolerability and effectiveness. |
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| Grant Information: | 001 International WHO_ World Health Organization |
| Substance Nomenclature: | 0 (Antitubercular Agents); VJT6J7R4TR (Rifampin) |
| Entry Date(s): | Date Created: 20230526 Date Completed: 20230529 Latest Revision: 20260521 |
| Update Code: | 20260521 |
| PubMed Central ID: | PMC10237267 |
| DOI: | 10.5588/ijtld.22.0613 |
| PMID: | 37231598 |
| Database: | MEDLINE |
Observational Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't