Outcomes of WHO-conforming, longer, all-oral multidrug-resistant TB regimens and analysis implications
Rich M.L. Khan U. Zeng C. LaHood A. Franke M.F. Atwood S. Bastard M. Burhan E. Danielyan N. Dzhazibekova P.M. Gadissa D. Ghafoor A. Hewison C. Islam M.S. Kazmi E. Khan P.Y. Lecca L. Maama L.B. Melikyan N. Naing Y.Y. Philippe K. Saki N.A. Seung K.J. Skrahina A. Tefera G.B. Varaine F. Vilbrun S.C. Võ L. Mitnick C.D. Huerga H.
1 June 2023International Union Against Tuberculosis and Lung Disease
International Journal of Tuberculosis and Lung Disease
2023#27Issue 6451 - 457 pp.
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.
effectiveness , fluoroquinolone , MDR-TB , multidrug-resistant TB , rifampicin resistance , RR-TB
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Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States
Partners In Health, Boston, MA, United States
Interactive Research and Development Global, Singapore, Singapore
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
Epicentre, Paris, France
Persahabatan General Hospital, Jakarta, Indonesia
Médecins Sans Frontières (MSF), Tbilisi, Georgia
National Science Center, Almaty, Kazakhstan
Partners In Health (PIH), Addis Ababa, Ethiopia
National Tuberculosis Programme (NTP), Ministry of National Health, Islamabad, Pakistan
MSF, Paris, France
Interactive Research and Development, Dhaka, Bangladesh
Directorate General Health Services, Centers for Disease Control and Prevention, Sindh, Pakistan
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
Socios En Salud Sucursal, Lima, Peru
PIH, Maseru, Lesotho
NTP, Maseru, Lesotho
MSF, Yerevan, Armenia
MSF, Yangon, Myanmar
Zanmi Lasante, Cange, Haiti
World Health Organization, Country Office, Dhaka, Bangladesh
MSF, Minsk, Belarus
GHESKIO Institute of Infectious Diseases and Reproductive Health, NTP, Haiti, Port-au-Prince, Haiti
Friends for International TB Relief, Ho Chi Minh City, Viet Nam
Division of Global Health Equity
Partners In Health
Interactive Research and Development Global
Department of Global Health and Social Medicine
Epicentre
Persahabatan General Hospital
Médecins Sans Frontières (MSF)
National Science Center
Partners In Health (PIH)
National Tuberculosis Programme (NTP)
MSF
Interactive Research and Development
Directorate General Health Services
Department of Clinical Research
Socios En Salud Sucursal
PIH
NTP
MSF
MSF
Zanmi Lasante
World Health Organization
MSF
GHESKIO Institute of Infectious Diseases and Reproductive Health
Friends for International TB Relief
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