Ahuja, Shama D.Ashkin, DavidAvendano, MonikaBanerjee, RitaBauer, MelissaBayona, Jamie N.Becerra, MercedesBenedetti, AndreaBurgos, MarcosCentis, RosellaChan, Eward D.Chiang, Chen-YuanCox, HelenD'Ambrosio, LiaDeRiemer, KathyDung, Nguyen HuyEnarson, DonaldFalzon, DennisFlanagan, KatherineFlood, JenniferGarcia-Garcia, Maria L.Gandhi, NeelGranich, Reuben M.Hollm-Delgado, Maria G.Holtz, Timothy H.Iseman, Michael D.Jarlsberg, Leah G.Keshavjee, SalmaanKim, Hye-RyounKoh, Won-JungLancaster, JoeyLange, Christophede Lange, Wiel C. M.Leimane, VairaLeung, Chi ChiuLi, JiehuiMenzies, DickMigliori, Giovanni B.Mishustin, Sergey P.Mitnick, CaroleNarita, MasaO'Riordan, PhillyPai, MadhukarPalmero, DomingoPark, Seung-kyuPasvol, GeoffreyPeña, JosePérez-Guzmán, CarlosQuelapio, Maria I. D.Ponce-de-Leon, AlfredoRiekstina, VijaRobert, JeromeRoyce, SarahSchaaf, H. SimonSeung, KwonjuneShah, LenaShim, Tae SunShin, SonyaShiraishi, YujiSifuentes-Osornio, JoséSotgiu, GiovanniStrand, Matthew J.Tabarsi, PayamTupasi, Thelma E.van Altena, RobertVan der Walt, MartieVan der Werf, Tjip S.Vargas, Mario H.Viiklepp, PirettWestenhouse, JaniceYew, Wing WaiYim, Jae-Joon2013-04-262012Ahuja, 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): e1001300.1549-1277http://nrs.harvard.edu/urn-3:HUL.InstRepos:10589800Background: 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.en-USMedicineGlobal HealthInfectious DiseasesPublic HealthJournal Article2013-04-2610.1371/journal.pmed.1001300