Outcomes of WHO-conforming, longer, all-oral multidrug- resistant TB regimens and analysis implications

被引：6

作者：

Rich, M. L. ^{[1
,2
,25
]}

Khan, U. ^{[3
]}

Zeng, C. ^{[4
]}

LaHood, A. ^{[4
]}

Franke, M. F. ^{[4
]}

Atwood, S. ^{[1
]}

Bastard, M. ^{[5
]}

Burhan, E. ^{[6
]}

Danielyan, N. ^{[7
]}

Dzhazibekova, P. M. ^{[8
]}

Gadissa, D. ^{[9
]}

Ghafoor, A. ^{[10
]}

Hewison, C. ^{[11
]}

Islam, M. S. ^{[12
]}

Kazmi, E. ^{[13
]}

Khan, P. Y. ^{[14
]}

Lecca, L. ^{[15
]}

Maama, L. B. ^{[16
,17
]}

Melikyan, N. ^{[5
,18
]}

Naing, Y. Y. ^{[19
]}

Philippe, K. ^{[20
]}

Saki, N. A. ^{[21
]}

Seung, K. J. ^{[1
,2
]}

Skrahina, A. ^{[22
]}

Tefera, G. B. ^{[9
]}

Varaine, F. ^{[11
]}

Vilbrun, S. C. ^{[23
]}

Vo, L. ^{[24
]}

Mitnick, C. D. ^{[1
,2
,4
]}

Huerga, H. ^{[5
]}

机构：

[1] Brigham & Womens Hosp, Div Global Hlth Equ, Boston, MA USA

[2] Partners Hlth, Boston, MA USA

[3] Interact Res & Dev Global, Singapore, Singapore

[4] Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA USA

[5] Epicentre, Paris, France

[6] Persahabatan Gen Hosp, Jakarta, Indonesia

[7] Med Sans Frontieres MSF, Tbilisi, Georgia

[8] Natl Sci Ctr, Alma Ata, Kazakhstan

[9] Partners Hlth PIH, Addis Ababa, Ethiopia

[10] Minist Natl Hlth, Natl TB Programme NTP, Islamabad, Pakistan

[11] MSF, Paris, France

[12] Interact Res & Dev, Dhaka, Bangladesh

[13] CDCP, Directorate Gen Hlth Serv, Sindh, Pakistan

[14] London Sch Hyg & Trop Med, Dept Clin Res, London, England

[15] Socios Salud Sucursal, Lima, Peru

[16] PIH, Maseru, Lesotho

[17] NTP, Maseru, Lesotho

[18] MSF, Yerevan, Armenia

[19] MSF, Yangon, Myanmar

[20] Zanmi Lasante, Cange, Haiti

[21] WHO, Country Off, Dhaka, Bangladesh

[22] MSF, Minsk, BELARUS

[23] GHESKIO Inst Infect Dis & Reprod Hlth, NTP, Port au Prince, Haiti

[24] Friends Int TB Relief, Ho Chi Minh City, Vietnam

[25] Partners Hlth, 800 Boylston St,Suite 300, Boston, MA 02199 USA

来源：

INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE | 2023年 / 27卷 / 06期

基金：

美国国家卫生研究院;

关键词：

effectiveness; MDR-TB; RR-TB; fluoro-quinolone; rifampicin resistance; multidrug-resistant TB; TUBERCULOSIS;

D O I：

10.5588/ijtld.22.0613

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

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 regi-mens 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.

引用

页码：451 / 457

页数：7

共 25 条

[1] Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis [J].

Ahmad, Nafees ;

Ahuja, Shama D. ;

Akkerman, Onno W. ;

Alffenaar, Jan-Willem C. ;

Anderson, Laura F. ;

Baghaei, Parvaneh ;

Bang, Didi ;

Barry, Pennan M. ;

Bastos, Mayara L. ;

Behera, Digamber ;

Benedetti, Andrea ;

Bisson, Gregory P. ;

Boeree, Martin J. ;

Bonnet, Maryline ;

Brode, Sarah K. ;

Brust, James C. M. ;

Cai, Ying ;

Caumes, Eric ;

Cegielski, J. Peter ;

Centis, Rosella ;

Chan, Pei-Chun ;

Chan, Edward D. ;

Chang, Kwok-Chiu ;

Charles, Macarthur ;

Cirule, Andra ;

Dalcolmo, Margareth Pretti ;

D'Ambrosio, Lia ;

de Vries, Gerard ;

Dheda, Keertan ;

Esmail, Aliasgar ;

Flood, Jennifer ;

Fox, Gregory J. ;

Frechet-Jachym, Mathilde ;

Fregona, Geisa ;

Gayoso, Regina ;

Gegia, Medea ;

Gler, Maria Tarcela ;

Gu, Sue ;

Guglielmetti, Lorenzo ;

Holtz, Timothy H. ;

Hughes, Jennifer ;

Isaakidis, Petros ;

Jarlsberg, Leah ;

Kempker, Russell R. ;

Keshavjee, Salmaan ;

Khan, Faiz Ahmad ;

Kipiani, Maia ;

Koenig, Serena P. ;

Koh, Won-Jung ;

Kritski, Afranio .

LANCET, 2018, 392 (10150) :821-834

[2] Treatment of Highly Drug-Resistant Pulmonary Tuberculosis [J].

Conradie, Francesca ;

Diacon, Andreas H. ;

Ngubane, Nosipho ;

Howell, Pauline ;

Everitt, Daniel ;

Crook, Angela M. ;

Mendel, Carl M. ;

Egizi, Erica ;

Moreira, Joanna ;

Timm, Juliano ;

McHugh, Timothy D. ;

Wills, Genevieve H. ;

Bateson, Anna ;

Hunt, Robert ;

Van Niekerk, Christo ;

Li, Mengchun ;

Olugbosi, Morounfolu ;

Spigelman, Melvin .

NEW ENGLAND JOURNAL OF MEDICINE, 2020, 382 (10) :893-902

[3]

endTB Consortium, 2019, TECHN BAS ENDTB OBS

[4]

endTB Consortium, 2018, endTB Clinical and Programmatic Guide for Patient Management with New TB Drugs

[5] Time for a change: considering regimen changes in analyses of observational drug-resistant TB treatment cohort data [J].

Franke, M. F. ;

Mitnick, C. D. .

INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, 2020, 24 (11) :1151-+

[6] Culture Conversion in Patients Treated with Bedaquiline and/or Delamanid A Prospective Multicountry Study [J].

Franke, Molly F. ;

Khan, Palwasha ;

Hewison, Cathy ;

Khan, Uzma ;

Huerga, Helena ;

Seung, Kwonjune J. ;

Rich, Michael L. ;

Zarli, Khin ;

Samieva, Nazgul ;

Oyewusi, Lawrence ;

Nair, Parvati ;

Mudassar, Mishaz ;

Melikyan, Nara ;

Lenggogeni, Putri ;

Lecca, Leonid ;

Kumsa, Andargachew ;

Khan, Munira ;

Islam, Shirajul ;

Hussein, Kerow ;

Docteur, Wisny ;

Chumburidze, Nino ;

Berikova, Elmira ;

Atshemyan, Hakob ;

Atwood, Sidney ;

Alam, Manzurul ;

Ahmed, Saman ;

Bastard, Mathieu ;

Mitnick, Carole D. .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2021, 203 (01) :111-119

[7] Evaluation of two short standardised regimens for the treatment of rifampicin-resistant tuberculosis (STREAM stage 2): an open-label, multicentre, randomised, non-inferiority trial [J].

Goodall, Ruth L. ;

Meredith, Sarah K. ;

Nunn, Andrew J. ;

Bayissa, Adamu ;

Bhatnagar, Anuj K. ;

Bronson, Gay ;

Chiang, Chen-Yuan ;

Conradie, Francesca ;

Gurumurthy, Meera ;

Kirenga, Bruce ;

Kiria, Nana ;

Meressa, Daniel ;

Moodliar, Ronelle ;

Narendran, Gopalan ;

Ngubane, Nosipho ;

Rassool, Mohammed ;

Sanders, Karen ;

Solanki, Rajesh ;

Squire, S. Bertel ;

Torrea, Gabriela ;

Tsogt, Bazarragchaa ;

Tudor, Elena ;

Van Deun, Armand ;

Rusen, I. D. .

LANCET, 2022, 400 (10366) :1858-1868

[8] Safety of Treatment Regimens Containing Bedaquiline and Delamanid in the endTB Cohort [J].

Hewison, Catherine ;

Khan, Uzma ;

Bastard, Mathieu ;

Lachenal, Nathalie ;

Coutisson, Sylvine ;

Osso, Elna ;

Ahmed, Saman ;

Khan, Palwasha ;

Franke, Molly F. ;

Rich, Michael L. ;

Varaine, Francis ;

Melikyan, Nara ;

Seung, Kwonjune J. ;

Adenov, Malik ;

Adnan, Sana ;

Danielyan, Narine ;

Islam, Shirajul ;

Janmohamed, Aleeza ;

Karakozian, Hayk ;

Kimenye, Maureen Kamene ;

Kirakosyan, Ohanna ;

Kholikulov, Begimkul ;

Krisnanda, Aga ;

Kumsa, Andargachew ;

Leblanc, Garmaly ;

Lecca, Leonid ;

Nkuebe, Mpiti ;

Mamsa, Shahid ;

Padayachee, Shrivani ;

Thit, Phone ;

Mitnick, Carole D. ;

Huerga, Helena .

CLINICAL INFECTIOUS DISEASES, 2022, 75 (06) :1006-1013

[9] Diagnostic Accuracy and Reproducibility of WHO-Endorsed Phenotypic Drug Susceptibility Testing Methods for First-Line and Second-Line Antituberculosis Drugs [J].

Horne, David J. ;

Pinto, Lancelot M. ;

Arentz, Matthew ;

Lin, S. -Y. Grace ;

Desmond, Edward ;

Flores, Laura L. ;

Steingart, Karen R. ;

Minion, Jessica .

JOURNAL OF CLINICAL MICROBIOLOGY, 2013, 51 (02) :393-401

[10] The endTB observational study protocol: treatment of MDR-TB with bedaquiline or delamanid containing regimens [J].

Khan, Uzma ;

Huerga, Helena ;

Khan, Aamir J. ;

Mitnick, Carole D. ;

Hewison, Catherine ;

Varaine, Francis ;

Bastard, Mathieu ;

Rich, Michael ;

Franke, Molly F. ;

Atwood, Sidney ;

Khan, Palwasha Y. ;

Seung, Kwonjune J. .

BMC INFECTIOUS DISEASES, 2019, 19 (01)

← 1 2 3 →