Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 Patients

被引：455

作者：

Ahuja, Shama D. ^{[1
]}

Ashkin, David ^{[2
]}

Avendano, Monika ^{[3
]}

Banerjee, Rita ^{[4
]}

Bauer, Melissa ^{[5
]}

Bayona, Jamie N. ^{[6
]}

Becerra, Mercedes C. ^{[7
,8
]}

Benedetti, Andrea ^{[5
]}

Burgos, Marcos ^{[9
]}

Centis, Rosella ^{[10
]}

Chan, Eward D. ^{[11
]}

Chiang, Chen-Yuan ^{[12
]}

Cox, Helen ^{[13
]}

D'Ambrosio, Lia ^{[10
]}

DeRiemer, Kathy ^{[14
]}

Nguyen Huy Dung ^{[15
]}

Enarson, Donald ^{[16
]}

Falzon, Dennis ^{[17
]}

Flanagan, Katherine ^{[18
]}

Flood, Jennifer

Garcia-Garcia, Maria L. ^{[19
]}

Gandhi, Neel ^{[20
]}

Granich, Reuben M. ^{[17
]}

Hollm-Delgado, Maria G. ^{[5
]}

Holtz, Timothy H. ^{[21
]}

Iseman, Michael D. ^{[22
]}

Jarlsberg, Leah G. ^{[23
]}

Keshavjee, Salmaan ^{[7
]}

Kim, Hye-Ryoun ^{[24
]}

Koh, Won-Jung ^{[25
]}

Lancaster, Joey ^{[26
]}

Lange, Christophe ^{[27
]}

de lange, Wiel C. M. ^{[28
]}

Leimane, Vaira ^{[29
]}

Leung, Chi Chiu ^{[30
]}

Li, Jiehui ^{[31
]}

Menzies, Dick ^{[5
]}

Migliori, Giovanni B. ^{[10
]}

Mishustin, Sergey P. ^{[32
]}

Mitnick, Carole D. ^{[7
]}

Narita, Masa ^{[33
]}

O'Riordan, Philly ^{[34
]}

Pai, Madhukar ^{[5
]}

Palmero, Domingo ^{[35
]}

Park, Seung-kyu ^{[36
]}

Pasvol, Geoffrey ^{[37
]}

Pena, Jose ^{[38
]}

Perez-Guzman, Carlos ^{[39
]}

Quelapio, Maria I. D. ^{[40
]}

Ponce-de-Leon, Alfredo ^{[41
]}

机构：

[1] Bur TB, New York, NY 11803 USA

[2] AG Holley Hosp, Lantana, FL USA

[3] Univ Toronto, Toronto, ON, Canada

[4] Mayo Clin, Rochester, MN USA

[5] McGill Univ, Montreal Chest Inst, Montreal, PQ, Canada

[6] Dartmouth Ctr Hlth Care Delivery Sci, Hanover, NH USA

[7] Harvard Univ, Sch Med, Boston, MA USA

[8] Partners Hlth, Boston, MA USA

[9] Univ New Mexico, Sch Med, Albuquerque, NM 87131 USA

[10] Fdn S Maugeri, Care & Res Inst, WHO Collaborating Ctr TB & Lung Dis, Tradate, Italy

[11] Denver Vet Affair Med Ctr, Denver, CO USA

[12] Taipei Med Univ, Sch Med, Wan Fang Hosp, Taipei, Taiwan

[13] Med Sans Frontieres, Cape Town, South Africa

[14] UC Davis Sch Med, Davis, CA USA

[15] Natl TB Control Program, Hanoi, Vietnam

[16] Int Union TB & Lung Dis, Paris, France

[17] WHO, CH-1211 Geneva, Switzerland

[18] MRC Labs, Banjul, Gambia

[19] Inst Nacl Salud Publ, Mexico City, DF, Mexico

[20] Albert Einstein Coll Med, Bronx, NY 10467 USA

[21] Thailand MOPH & US CDC Collaborat, Bangkok, Thailand

[22] Natl Jewish Hlth, Denver, CO USA

[23] Univ Calif San Francisco, San Francisco, CA 94143 USA

[24] Korea Canc Ctr Hosp, Seoul, South Korea

[25] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Seoul, South Korea

[26] S African MRC, Pretoria, South Africa

[27] TB Ctr Borstel, Med Clin, Borstel, Germany

[28] Univ Groningen, Univ Med Ctr Groningen, NL-9713 AV Groningen, Netherlands

[29] Clin TB & Lung Dis, Riga, Latvia

[30] TB & Chest Serv, Hong Kong, Hong Kong, Peoples R China

[31] New York City Hlth & Mental Hyg, New York, NY USA

[32] Tomsk Oblast TB Dispensary, Tomsk, Russia

[33] Univ Washington, Seattle, WA 98195 USA

[34] City Rd Med Ctr, London, England

[35] Hosp FJ Muniz, Buenos Aires, DF, Argentina

[36] TB Ctr, Seoul, South Korea

[37] Univ London Imperial Coll Sci Technol & Med, London, England

[38] Univ Autonoma Madrid, Madrid, Spain

[39] Inst Salud Estado Aguascalientes, Mexico City, DF, Mexico

[40] Trop Dis Fdn, Makati, Philippines

[41] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico

[42] Bacteriol Hyg UPMC, Paris, France

[43] Univ Stellenbosch, ZA-7600 Stellenbosch, South Africa

[44] Brigham & Womens Hosp, Boston, MA 02115 USA

[45] Univ Ulsan, Coll Med, Seoul, South Korea

[46] Fukujuji Hosp, Tokyo, Japan

[47] Shaheed Beheshti Med Univ, Tehran, Iran

[48] Univ Sassari, I-07100 Sassari, Italy

[49] Inst Nacl Enfermedades Resp, Mexico City, DF, Mexico

[50] Natl Inst Hlth Dev, Tallinn, Estonia

来源：

PLOS MEDICINE | 2012年 / 9卷 / 08期

基金：

英国惠康基金; 英国医学研究理事会; 美国国家卫生研究院;

关键词：

SHORT-COURSE CHEMOTHERAPY; STANDARDIZED REGIMENS; DRUG-RESISTANCE; DOTS-PLUS; FOLLOW-UP; TB; PROGRAM; COHORT; INTERVENTION; PHILIPPINES;

D O I：

10.1371/journal.pmed.1001300

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：16

共 61 条

[1]

Akcakir Y, 2010, THESIS MCGILL U MONT

[2]

[Anonymous], 2006, Weekly Epidemiological Record, V81, P430

[3]

Avendano M, 2000, Can Respir J, V7, P383

[4] Extensively drug-resistant tuberculosis in California, 1993-2006 [J].