Effect of smoking on drug-resistant tuberculosis treatment outcomes and potential mechanistic pathways: a multicountry cohort study.
| Title: | Effect of smoking on drug-resistant tuberculosis treatment outcomes and potential mechanistic pathways: a multicountry cohort study. |
|---|---|
| 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, Massachusetts, USA.; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, 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 & Development, Durban, South Africa.; Herrera Flores E; National Hospital Arzobispo Loayza, Lima District, Peru.; Oyewusi L; Partners In Health, Maseru, Lesotho.; Khan PY; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.; Interactive Research & Development, Singapore.; Huerga H; Epicentre, Paris, France.; Bastard M; Epicentre, Paris, France.; Rich ML; Partners In Health, Boston, Massachusetts, USA.; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Tefera GB; Partners In Health, Addis Ababa, Ethiopia.; Rashitov M; Partners In Health, Almaty, Kazakhstan.; Kirakosyan O; Médecins Sans Frontières, Yerevan, Armenia.; Krisnanda A; Interactive Research & Development, Jakarta, Indonesia.; Toktogonova A; National Tuberculosis Center, Bishkek, Kyrgyzstan.; Siddiqui MR; Institute of Chest Diseases, 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 molly_franke@hms.harvard.edu. |
| Corporate Authors: | endTB Observational Study Team |
| Source: | BMJ open respiratory research [BMJ Open Respir Res] 2025 Dec 25; Vol. 12 (1). Date of Electronic Publication: 2025 Dec 25. |
| Publication Type: | Journal Article; Observational Study; Multicenter Study |
| Language: | English |
| Journal Info: | Publisher: BMJ Publishing Group Ltd & British Thoracic Society Country of Publication: England NLM ID: 101638061 Publication Model: Electronic Cited Medium: Internet ISSN: 2052-4439 (Electronic) Linking ISSN: 20524439 NLM ISO Abbreviation: BMJ Open Respir Res Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : BMJ Publishing Group Ltd & British Thoracic Society, [2013]- |
| MeSH Terms: | Antitubercular Agents*/therapeutic use ; Cigarette Smoking*/epidemiology ; Cigarette Smoking*/adverse effects ; Tuberculosis, Multidrug-Resistant*/drug therapy ; Tuberculosis, Multidrug-Resistant*/epidemiology; Rifampin/therapeutic use ; Adult ; Female ; Humans ; Male ; Middle Aged ; Comorbidity ; Prospective Studies ; Treatment Outcome |
| Abstract: | Background: People who smoke are at increased risk of unfavourable tuberculosis treatment outcomes compared with those who do not, but the pathways that explain this disparity are unclear.; Objective: To estimate the difference in a successful end-of-treatment outcome by smoking status among people with multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) and to examine if this difference changes if people who smoked had the same retention in treatment as those who did not smoke.; Design and Methods: Using data from the prospective endTB Observational Study, we estimated the difference in treatment success by cigarette smoking status, adjusting for baseline confounders including demographics, social history and comorbidities. To examine how this difference changed if everyone was retained in treatment, we censored participants who were lost to follow-up and applied inverse probability of censoring weights to simulate this scenario.; Results: Among 1786 participants in 12 countries, 539 (30.2%) reported smoking at least one cigarette daily. People who smoked were more frequently found in post-Soviet countries and had a complex social history (eg, incarceration and substance use) and infectious comorbidities (eg, hepatitis C). 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 to -2.6). After adjusting for baseline confounders, the risk difference was similar (-5.2 percentage points), but the 95% CI was less precise (-14.1 to 3.2). When simulating a scenario in which everyone was retained in treatment, the risk difference was attenuated (-1.9 percentage points; 95% CI -11.1 to 4.7).; Conclusion: People who smoked had a lower frequency of MDR/RR-TB treatment success than those who did not smoke. Eliminating loss to follow-up reduced this difference by smoking status, suggesting that pathways related to retention in treatment were a major driver of this disparity.; (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.) |
| Competing Interests: | Competing interests: MLRo reports research funding from the National Institutes of Health with payments made to their institution. HRS reports research funding from the UK Medical Research Council with payments made to their institution. CDM, MLRi and MFF 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. CDM 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 of: medRxiv. 2025 Aug 24:2025.08.20.25334077. doi: 10.1101/2025.08.20.25334077.. (PMID: 40894162) |
| References: | PLoS One. 2020 Sep 17;15(9):e0239333. (PMID: 32941508); Am J Trop Med Hyg. 2020 Dec;103(6):2501-2505. (PMID: 32975178); BMC Infect Dis. 2024 May 27;24(1):531. (PMID: 38802744); Eur Respir J. 2015 Mar;45(3):738-45. (PMID: 25359352); Sci Rep. 2023 Dec 15;13(1):22361. (PMID: 38102144); ERJ Open Res. 2020 Nov 02;6(4):. (PMID: 33263043); Subst Abuse Treat Prev Policy. 2011 Sep 23;6:26. (PMID: 21943384); J Clin Epidemiol. 2022 Apr;144:203-205. (PMID: 34461211); Int J Tuberc Lung Dis. 2017 Aug 1;21(8):887-893. (PMID: 28786797); Public Health. 2020 Oct;187:24-35. (PMID: 32889229); PLoS One. 2018 Oct 17;13(10):e0203937. (PMID: 30332406); BMC Public Health. 2023 Jul 10;23(1):1317. (PMID: 37430295); BMC Infect Dis. 2019 Aug 20;19(1):733. (PMID: 31429722); Public Health Action. 2022 Jun 21;12(2):55-57. (PMID: 35734003); Eur Respir J. 2019 Jul 11;54(1):. (PMID: 31073080); Int J Tuberc Lung Dis. 2020 Feb 1;24(2):170-175. (PMID: 32127100); Sci Rep. 2018 Mar 21;8(1):4980. (PMID: 29563561); Eur Respir J. 2019 Jan 10;53(1):. (PMID: 30309972); Clin Infect Dis. 2025 Aug 22;:. (PMID: 40843468); Tob Induc Dis. 2020 Jul 14;18:60. (PMID: 32765200); Lancet Infect Dis. 2025 Jul;25(7):764-774. (PMID: 39923785); Eur Respir Rev. 2022 Jun 7;31(164):. (PMID: 35675921); Int J Tuberc Lung Dis. 2023 Apr 1;27(4):338-340. (PMID: 37035974); Public Health Action. 2018 Jun 21;8(2):50-58. (PMID: 29946520); Transl Behav Med. 2020 Dec 31;10(6):1491-1503. (PMID: 31233146); Thorax. 2022 Jan;77(1):74-78. (PMID: 34272336); Eur Respir J. 2020 Aug 6;56(2):. (PMID: 32366485); Int J Tuberc Lung Dis. 2005 Apr;9(4):430-6. (PMID: 15830749); J Infect. 2018 Nov;77(5):357-367. (PMID: 30036607); Indian J Tuberc. 2023 Oct;70(4):475-482. (PMID: 37968054); PLoS One. 2023 Aug 17;18(8):e0281918. (PMID: 37590225); Am J Epidemiol. 2018 Sep 1;187(9):1846-1855. (PMID: 29635332); J Glob Health. 2024 Sep 6;14:04187. (PMID: 39238358); BMC Public Health. 2021 Oct 21;21(1):1903. (PMID: 34670527); Chest. 2024 Jan;165(1):22-47. (PMID: 37652295); Int J Tuberc Lung Dis. 2020 Jan 1;24(1):73-82. (PMID: 32005309) |
| Grant Information: | R03 AI180576 United States AI NIAID NIH HHS |
| Contributed Indexing: | Keywords: Clinical Epidemiology; Compliance; Tobacco and the lung; Tuberculosis |
| Substance Nomenclature: | 0 (Antitubercular Agents); VJT6J7R4TR (Rifampin) |
| Entry Date(s): | Date Created: 20251225 Date Completed: 20251225 Latest Revision: 20260108 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12742115 |
| DOI: | 10.1136/bmjresp-2025-003777 |
| PMID: | 41448789 |
| Database: | MEDLINE |
Journal Article; Observational Study; Multicenter Study