Effect of smoking on drug-resistant tuberculosis treatment outcomes and potential mechanistic pathways: a multicountry cohort study

Romo M.L. LaHood A. Stagg H.R. Mitnick C.D. Trevisi L. Hewison C. Padayachee S. Herrera Flores E. Oyewusi L. Khan P.Y. Huerga H. Bastard M. Rich M.L. Tefera G.B. Rashitov M. Kirakosyan O. Krisnanda A. Toktogonova A. Siddiqui M.R. Gómez-Restrepo C. Kotrikadze T. Franke M.F.
25 December 2025 BMJ Publishing Group

BMJ Open Respiratory Research
2025 #12 Issue 1

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 (−5.2percentage 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 (−1.9percentage 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.

Clinical Epidemiology , Compliance , Tobacco and the lung , Tuberculosis

Text of the article Перейти на текст статьи

Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, United States
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
Partners In Health, Boston, MA, United States
Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States
Médecins Sans Frontières, Paris, France
Interactive Research & Development, Durban, South Africa
National Hospital Arzobispo Loayza, Lima District, Peru
Partners In Health, Maseru, Lesotho
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
Interactive Research & Development, Singapore
Epicentre, Paris, France
Partners In Health, Addis Ababa, Ethiopia
Partners In Health, Almaty, Kazakhstan
Médecins Sans Frontières, Yerevan, Armenia
Interactive Research & Development, Jakarta, Indonesia
National Tuberculosis Center, Bishkek, Kyrgyzstan
Institute of Chest Diseases, Kotri, Pakistan
Médecins Sans Frontières, Yangon, Myanmar
Médecins Sans Frontières, Tbilisi, Georgia

Department of Global Health and Social Medicine
Department of Epidemiology
Department of Infectious Disease Epidemiology
Partners In Health
Division of Global Health Equity
Médecins Sans Frontières
Interactive Research & Development
National Hospital Arzobispo Loayza
Partners In Health
Department of Clinical Research
Interactive Research & Development
Epicentre
Partners In Health
Partners In Health
Médecins Sans Frontières
Interactive Research & Development
National Tuberculosis Center
Institute of Chest Diseases
Médecins Sans Frontières
Médecins Sans Frontières

10 лет помогаем публиковать статьи Международный издатель

Книга Публикация научной статьи Волощук 2026 Book Publication of a scientific article 2026