TY - JOUR
T1 - Resistance to fluoroquinolones and second-line injectable drugs
T2 - Impact on multidrug-resistant TB outcomes
AU - Collaborative Group for Meta-Analysis of Individual Patient Data in MDR-TB
AU - Falzon, Dennis
AU - Gandhi, Neel
AU - Migliori, Giovanni B.
AU - Sotgiu, Giovanni
AU - Cox, Helen S.
AU - Holtz, Timothy H.
AU - Hollm-Delgado, Maria Graciela
AU - Keshavjee, Salmaan
AU - DeRiemer, Kathryn
AU - Centis, Rosella
AU - D'Ambrosio, Lia
AU - Lange, Christoph G.
AU - Bauer, Melissa
AU - Menzies, Dick
AU - Ahuja, S. D.
AU - Ashkin, D.
AU - Avendaño, M.
AU - Banerjee, R.
AU - Becerra, M. C.
AU - Benedetti, A.
AU - Burgos, M.
AU - Chan, E. D.
AU - Chiang, C. Y.
AU - Cobelens, F.
AU - Cox, H.
AU - De Lange, W. C.M.
AU - Enarson, D.
AU - Flanagan, K. L.
AU - Flood, J.
AU - Garcia-Garcia, M. L.
AU - Granich, R. M.
AU - Hopewell, P.
AU - Iseman, M. D.
AU - Jarlsberg, L. G.
AU - Kim, H. R.
AU - Koh, W. J.
AU - Lancaster, J. L.
AU - Lange, C.
AU - Leimane, V.
AU - Leung, C. C.
AU - Li, J.
AU - Mitnick, C. D.
AU - Narita, M.
AU - Nathanson, E.
AU - Odendaal, R.
AU - O'Riordan, P.
AU - Pai, M.
AU - Palmero, D.
AU - Park, S. K.
AU - Pasvol, G.
PY - 2013/7/1
Y1 - 2013/7/1
N2 - A meta-analysis for response to treatment was undertaken using individual data of multidrug-resistant tuberculosis (MDR-TB) (resistance to isoniazid and rifampicin) patients from 26 centres. The analysis assessed the impact of additional resistance to fluoroquinolones and/or second-line injectable drugs on treatment outcome. Compared with treatment failure, relapse and death, treatment success was higher in MDR-TB patients infected with strains without additional resistance (n=4763; 64%, 95%CI 57-72%) or with resistance to second-line injectable drugs only (n=1130; 56%, 95%CI 45-66%), than in those having resistance to fluoroquinolones alone (n=426; 48%, 95%CI 36-60%) or to fluoroquinolones plus second-line injectable drugs (extensively drug resistant (XDR)-TB) (n=405; 40%, 95%CI 27-53%). In XDR-TB patients, treatment success was highest if at least six drugs were used in the intensive phase (adjusted OR 4.9, 95%CI 1.4-16.6; reference fewer than three drugs) and four in the continuation phase (OR 6.1, 95%CI 1.4-26.3). The odds of success in XDR-TB patients was maximised when the intensive phase reached 6.6-9.0 months duration and the total duration of treatment 20.1-25.0 months. In XDR-TB patients, regimens containing more drugs than those recommended in MDR-TB but given for a similar duration were associated with the highest odds of success. All data were from observational studies and methodologies varied between centres, therefore, the bias may be substantial. Better quality evidence is needed to optimise regimens.
AB - A meta-analysis for response to treatment was undertaken using individual data of multidrug-resistant tuberculosis (MDR-TB) (resistance to isoniazid and rifampicin) patients from 26 centres. The analysis assessed the impact of additional resistance to fluoroquinolones and/or second-line injectable drugs on treatment outcome. Compared with treatment failure, relapse and death, treatment success was higher in MDR-TB patients infected with strains without additional resistance (n=4763; 64%, 95%CI 57-72%) or with resistance to second-line injectable drugs only (n=1130; 56%, 95%CI 45-66%), than in those having resistance to fluoroquinolones alone (n=426; 48%, 95%CI 36-60%) or to fluoroquinolones plus second-line injectable drugs (extensively drug resistant (XDR)-TB) (n=405; 40%, 95%CI 27-53%). In XDR-TB patients, treatment success was highest if at least six drugs were used in the intensive phase (adjusted OR 4.9, 95%CI 1.4-16.6; reference fewer than three drugs) and four in the continuation phase (OR 6.1, 95%CI 1.4-26.3). The odds of success in XDR-TB patients was maximised when the intensive phase reached 6.6-9.0 months duration and the total duration of treatment 20.1-25.0 months. In XDR-TB patients, regimens containing more drugs than those recommended in MDR-TB but given for a similar duration were associated with the highest odds of success. All data were from observational studies and methodologies varied between centres, therefore, the bias may be substantial. Better quality evidence is needed to optimise regimens.
UR - http://www.scopus.com/inward/record.url?scp=84880162469&partnerID=8YFLogxK
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U2 - 10.1183/09031936.00134712
DO - 10.1183/09031936.00134712
M3 - Article
C2 - 23100499
AN - SCOPUS:84880162469
SN - 0903-1936
VL - 42
SP - 156
EP - 168
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 1
ER -