Effect of smoking on drug-resistant tuberculosis treatment outcomes and exploring potential pathways: A multicountry cohort study.
| Title: | Effect of smoking on drug-resistant tuberculosis treatment outcomes and exploring potential pathways: A multicountry cohort study. |
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| Authors: | Romo ML; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.; LaHood A; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Stagg HR; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.; Mitnick CD; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Partners In Health, Boston, MA, USA.; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.; Trevisi L; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Hewison C; Médecins Sans Frontières, Paris, France.; Padayachee S; Interactive Research and Development, Durban, South Africa.; Flores EH; Arzobispo Loayza Hospital, Lima, Peru.; Oyewusi L; Partners In Health, Lesotho, Maseru, Lesotho.; Khan PY; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.; Interactive Research and Development Global, Singapore, Singapore.; Huerga H; Epicentre, Paris, France.; Bastard M; Epicentre, Paris, France.; Rich ML; Partners In Health, Boston, MA, USA.; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.; Tefera GB; Partners In Health, Ethiopia, Addis Ababa, Ethiopia.; Rashitov M; Partners In Health, Almaty, Kazakhstan.; Kirakosyan O; Médecins Sans Frontières, Yerevan, Armenia.; Krisnanda A; Interactive Research and Development, Jakarta, Indonesia.; Toktogonova A; National Tuberculosis Center, Bishkek, Kyrgyzstan.; Siddiqui MR; Institute of Chest Diseases (ICD), Kotri, Pakistan.; Gómez-Restrepo C; Médecins Sans Frontières, Yangon, Myanmar.; Kotrikadze T; Médecins Sans Frontières, Tbilisi, Georgia.; Franke MF; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. |
| Corporate Authors: | endTB Observational Study Team |
| Source: | MedRxiv : the preprint server for health sciences [medRxiv] 2025 Aug 24. Date of Electronic Publication: 2025 Aug 24. |
| Publication Type: | Journal Article; Preprint |
| Language: | English |
| Journal Info: | Country of Publication: United States NLM ID: 101767986 Publication Model: Electronic Cited Medium: Internet NLM ISO Abbreviation: medRxiv Subsets: PubMed not MEDLINE |
| Abstract: | People who smoke are at increased risk of unfavorable tuberculosis (TB) treatment outcomes compared with those who do not, but the pathways explaining this effect are unclear. We estimated the effect of smoking on a successful end-of-treatment outcome for multidrug-resistant and rifampicin-resistant (MDR/RR) TB and examined if intervening on loss to follow-up mitigates this effect. The endTB Observational Study was a prospective cohort of people with MDR/RR-TB who were treated with longer regimens containing bedaquiline and/or delamanid. We used marginal standardization to examine the effect of smoking (≥1 cigarette daily at enrollment) on treatment success (cured/completed). To simulate intervening on lost to follow-up, we censored participants and applied inverse probability of censoring weights. Among 1786 participants in 12 countries, 539 (30.2%) reported smoking. At the end of treatment, 73.5% of people who smoked and 80.3% of people who did not smoke had treatment success (risk difference in percentage points: -6.8, 95% CI: -11.1, -2.6). After adjusting for baseline confounders including demographics, social history, and comorbidities, the risk difference was similar (-5.2 percentage points) but 95% CIs were less precise (-14.1, 3.2). In a pseudopopulation without loss to follow-up, the risk difference was reduced (-1.9 percentage points; 95% CI: -10.2, 5.1). People who smoked had less frequent MDR/RR-TB treatment success compared with those who did not smoke. A simulated intervention on loss to follow-up reduced this difference, suggesting that pathways related to retention in care were a driver of this effect. |
| Competing Interests: | Conflicts of interest: Matthew L. Romo reports research funding from the National Institutes of Health with payments made to their institution. Helen R. Stagg reports research funding from the UK Medical Research Council with payments made to their institution. Carole D. Mitnick, Michael L. Rich, and Molly F. Franke report research funding from Unitaid, the National Institutes of Health, and Harvard Medical School Center for Global Health Delivery-Dubai with payment made to their institutions. Carole D. Mitnick also reports participation in scientific advisory boards for Akagera (one payment made to Partners In Health as an honorarium for service on the advisory board) and Otsuka (no payment). The remaining authors declare no potential conflicts of interest. |
| Comments: | Update in: BMJ Open Respir Res. 2025 Dec 25;12(1):e003777. doi: 10.1136/bmjresp-2025-003777.. (PMID: 41448789) |
| Grant Information: | R03 AI180576 United States AI NIAID NIH HHS |
| Contributed Indexing: | Keywords: Lost to Follow-Up; Multidrug-Resistant; Mycobacterium tuberculosis; Tobacco Smoking; Treatment Adherence and Compliance; Tuberculosis |
| Entry Date(s): | Date Created: 20250902 Date Completed: 20251230 Latest Revision: 20251230 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12393624 |
| DOI: | 10.1101/2025.08.20.25334077 |
| PMID: | 40894162 |
| Database: | MEDLINE |
Journal Article; Preprint