Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 Patients
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Author
Ahuja, Shama D.
Ashkin, David
Avendano, Monika
Banerjee, Rita
Bauer, Melissa
Bayona, Jamie N.
Benedetti, Andrea
Burgos, Marcos
Centis, Rosella
Chan, Eward D.
Chiang, Chen-Yuan
Cox, Helen
D'Ambrosio, Lia
DeRiemer, Kathy
Dung, Nguyen Huy
Enarson, Donald
Falzon, Dennis
Flanagan, Katherine
Flood, Jennifer
Garcia-Garcia, Maria L.
Gandhi, Neel
Granich, Reuben M.
Hollm-Delgado, Maria G.
Holtz, Timothy H.
Iseman, Michael D.
Jarlsberg, Leah G.
Kim, Hye-Ryoun
Koh, Won-Jung
Lancaster, Joey
Lange, Christophe
de Lange, Wiel C. M.
Leimane, Vaira
Leung, Chi Chiu
Li, Jiehui
Menzies, Dick
Migliori, Giovanni B.
Mishustin, Sergey P.
Narita, Masa
O'Riordan, Philly
Pai, Madhukar
Palmero, Domingo
Park, Seung-kyu
Pasvol, Geoffrey
Peña, Jose
Pérez-Guzmán, Carlos
Quelapio, Maria I. D.
Ponce-de-Leon, Alfredo
Riekstina, Vija
Robert, Jerome
Royce, Sarah
Schaaf, H. Simon
Shah, Lena
Shim, Tae Sun
Shiraishi, Yuji
Sifuentes-Osornio, José
Sotgiu, Giovanni
Strand, Matthew J.
Tabarsi, Payam
Tupasi, Thelma E.
van Altena, Robert
Van der Walt, Martie
Van der Werf, Tjip S.
Vargas, Mario H.
Viiklepp, Pirett
Westenhouse, Janice
Yew, Wing Wai
Yim, Jae-Joon
Note: Order does not necessarily reflect citation order of authors.
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https://doi.org/10.1371/journal.pmed.1001300Metadata
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Ahuja, Shama D., David Ashkin, Monika Avendano, Rita Banerjee, Melissa Bauer, Jamie N. Bayona, Mercedes C. Becerra, et al. 2012. Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients. PLoS Medicine 9(8): e1001300.Abstract
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.Other Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429397/pdf/Terms of Use
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