Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 Patients
Por:
Ahuja S.D., Ashkin D., Avendano M., Banerjee R., Bauer M., Bayona J.N., Becerra M.C., Benedetti A., Burgos M., Centis R., Chan E.D., Chiang C.-Y., Cox H., D'Ambrosio L., DeRiemer K., Dung N.H., Enarson D., Falzon D., Flanagan K., Flood J., Garcia-Garcia M.L., Gandhi N., Granich R.M., Hollm-Delgado M.G., Holtz T.H., Iseman M.D., Jarlsberg L.G., Keshavjee S., Kim H.-R., Koh W.-J., Lancaster J., Lange C., de Lange W.C.M., Leimane V., Leung C.C., Li J., Menzies D., Migliori G.B., Mishustin S.P., Mitnick C.D., Narita M., O'Riordan P., Pai M., Palmero D., Park S.-k., Pasvol G., Peña J., Pérez-Guzmán C., Quelapio M.I.D., Ponce-de-Leon A., Riekstina V., Robert J., Royce S., Schaaf H.S., Seung K.J., Shah L., Shim T.S., Shin S.S., Shiraishi Y., Sifuentes-Osornio J., Sotgiu G., Strand M.J., Tabarsi P., Tupasi T.E., van Altena R., van der Walt M., van der Werf T.S., Vargas M.H., Viiklepp P., Westenhouse J., Yew W.W., Yim J.-J.
Publicada:
1 ene 2012
Categoría:
Medicine (miscellaneous)
Resumen:
Background: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. Methods and Findings: Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]).Conclusions:In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment.Please see later in the article for the Editors' Summary. © 2012 Ahuja et al.
Filiaciones:
Ahuja S.D.:
Bureau of Tuberculosis, New York, NY, United States
Ashkin D.:
A.G. Holley Hospital, Lantana, FL, United States
Avendano M.:
University of Toronto, Toronto, Canada
Banerjee R.:
Mayo Clinic, Rochester, MN, United States
Bauer M.:
Montreal Chest Institute, McGill University, Montreal, Canada
Bayona J.N.:
The Dartmouth Center for Health Care Delivery Science, Hanover, NH, United States
Becerra M.C.:
Harvard Medical School, Boston, MA, United States
Partners in Health, Boston, MA, United States
Benedetti A.:
Montreal Chest Institute, McGill University, Montreal, Canada
Burgos M.:
University of New Mexico School of Medicine, Albuquerque, NM, United States
Centis R.:
WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy
Chan E.D.:
Denver Veterans Affair Medical Center, Denver, CO, United States
Chiang C.-Y.:
Wan Fang Hospital, School of Medicine-Taipei Medical University, Taiwan
Cox H.:
Médecins Sans Frontières, Capetown, South Africa
D'Ambrosio L.:
WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy
DeRiemer K.:
UC Davis School of Medicine, Davis, CA, United States
Dung N.H.:
National TB Control Program, Hanoi, Viet Nam
Enarson D.:
International Union Against Tuberculosis and Lung Disease, Paris, France
Falzon D.:
World Health Organization, Geneva, Switzerland
Flanagan K.:
MRC Laboratories, Banjul, Gambia
Flood J.:
California Department of Public Health, Sacramento, CA, United States
Garcia-Garcia M.L.:
Instituto Nacional de Salud Publica, Mexico, Mexico
Gandhi N.:
Albert Einstein College of Medicine, Bronx, NY, United States
Granich R.M.:
World Health Organization, Geneva, Switzerland
Hollm-Delgado M.G.:
Montreal Chest Institute, McGill University, Montreal, Canada
Holtz T.H.:
Thailand MOPH and US CDC Collaboration, Bangkok, Thailand
Iseman M.D.:
National Jewish Health, Denver, Co, United States
Jarlsberg L.G.:
University of California, San Francisco, San Francisco, United States
Keshavjee S.:
Harvard Medical School, Boston, MA, United States
Kim H.-R.:
Korea Cancer Center Hospital, Seoul, South Korea
Koh W.-J.:
Samsung Medical Center, Seoul, South Korea
Lancaster J.:
South African Medical Research Council, Pretoria, South Africa
Lange C.:
Medical Clinic, Tuberculosis Center Borstel, Borstel, Germany
de Lange W.C.M.:
University Medical Center Groningen, Groningen, Netherlands
Leimane V.:
Clinic of Tuberculosis and Lung Diseases, Riga, Latvia
Leung C.C.:
Tuberculosis and Chest Services, Hong Kong
Li J.:
New York City Health and Mental Hygiene, New York, NY, United States
Menzies D.:
Montreal Chest Institute, McGill University, Montreal, Canada
Migliori G.B.:
WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy
Mishustin S.P.:
Tomsk Oblast Tuberculosis Dispensary, Tomsk, Russian Federation
Mitnick C.D.:
Harvard Medical School, Boston, MA, United States
Narita M.:
University of Washington, Seattle, WA, United States
O'Riordan P.:
City Road Medical Centre, London, United Kingdom
Pai M.:
Montreal Chest Institute, McGill University, Montreal, Canada
Palmero D.:
Hospital F.J. Muñiz, Buenos Aires, Argentina
Park S.-k.:
TB Center, Seoul, South Korea
Pasvol G.:
Imperial College London, London, United Kingdom
Peña J.:
Universidad Autonoma Madrid, Madrid, Spain
Pérez-Guzmán C.:
Instituto de Salud del Estado de Aguascalientes, Mexico, Mexico
Quelapio M.I.D.:
Tropical Disease Foundation, Makati City, Philippines
Ponce-de-Leon A.:
Instituto Nacional de Ciencias Medicas y de Nutricion Salvador Zubiran, Mexico, Mexico
Riekstina V.:
Clinic of Tuberculosis and Lung Diseases, Riga, Latvia
Robert J.:
Bacteriologie-Hygiene - UPMC, Paris, France
Royce S.:
University of California, San Francisco, San Francisco, United States
Schaaf H.S.:
Stellenbosch University, Stellenbosch, South Africa
Seung K.J.:
Brigham and Women's Hospital, Boston, MA, United States
Shah L.:
Montreal Chest Institute, McGill University, Montreal, Canada
Shim T.S.:
University of Ulsan College of Medicine, Seoul, South Korea
Shin S.S.:
Brigham and Women's Hospital, Boston, MA, United States
Shiraishi Y.:
Fukujuji Hospital, Tokyo, Japan
Sifuentes-Osornio J.:
Instituto Nacional de Ciencias Medicas y de Nutricion Salvador Zubiran, Mexico, Mexico
Sotgiu G.:
University of Sassari, Sassari, Italy
Strand M.J.:
National Jewish Health, Denver, Co, United States
Tabarsi P.:
Shaheed Beheshti Medical University, Tehran, Iran
Tupasi T.E.:
Tropical Disease Foundation, Makati City, Philippines
van Altena R.:
University Medical Center Groningen, Groningen, Netherlands
van der Walt M.:
South African Medical Research Council, Pretoria, South Africa
van der Werf T.S.:
University Medical Center Groningen, Groningen, Netherlands
Vargas M.H.:
Instituto Nacional de Enfermedades Respiratorias, México, Mexico
Viiklepp P.:
National Institute for Health Development, Tallinn, Estonia
Westenhouse J.:
Center for Infectious Diseases-California Department of Public Health, Sacramento, CA, United States
Yew W.W.:
Grantham Hospital, Hong Kong
Yim J.-J.:
Seoul National University College of Medicine, Seoul, South Korea
Gold
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