Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis

Nafees Ahmad; Shama D. Ahuja; Onno W. Akkerman; Jan-Willem C. Alffenaar; Laura F. Anderson; Parvaneh Baghaei; Didi Bang; Pennan M. Barry; Mayara L. Bastos; Digamber Behera; Andrea Benedetti; Gregory P. Bisson; Martin J. Boeree; Maryline Bonnet; Sarah K. Brode; James C. M. Brust; Ying Cai; Eric Caumes; J. Peter Cegielski; Rosella Centis; Pei-Chun Chan; Edward D. Chan; Kwok-Chiu Chang; Macarthur Charles; Andra Cirule; Margareth Pretti Dalcolmo; Lia D'Ambrosio; Gerard de Vries; Keertan Dheda; Aliasgar Esmail; Jennifer Flood; Gregory J. Fox; Mathilde Frechet-Jachym; Geisa Fregona; Regina Gayoso; Medea Gegia; Maria Tarcela Gler; Sue Gu; Lorenzo Guglielmetti; Timothy H. Holtz; Jennifer Hughes; Petros Isaakidis; Leah Jarlsberg; Russell R. Kempker; Salmaan Keshavjee; Faiz Ahmad Khan; Maia Kipiani; Serena P. Koenig; Won-Jung Koh; Afranio Kritski; Liga Kuksa; Charlotte L. Kvasnovsky; Nakwon Kwak; Zhiyi Lan; Christoph Lange; Rafael Laniado-Laborin; Myungsun Lee; Vaira Leimane; Chi-Chiu Leung; Eric Chung-Ching Leung; Pei Zhi Li; Phil Lowenthal; Ethel L. Maciel; Suzanne M. Marks; Sundari Mase; Lawrence Mbuagbaw; Giovanni B. Migliori; Vladimir Milanov; Ann C. Miller; Carole D. Mitnick; Chawangwa Modongo; Erika Mohr; Ignacio Monedero; Payam Nahid; Norbert Ndjeka; Max R. O'Donnell; Nesri Padayatchi; Domingo Palmero; Jean William Pape; Laura J. Podewils; Ian Reynolds; Vija Riekstina; Jerome Robert; Maria Rodriguez; Barbara Seaworth; Kwonjune J. Seung; Kathryn Schnippel; Tae Sun Shim; Rupak Singla; Sarah E. Smith; Giovanni Sotgiu; Ganzaya Sukhbaatar; Payam Tabarsi; Simon Tiberi; Anete Trajman; Lisa Trieu; Zarir F. Udwadia; Tjip S. van der Werf; Nicolas Veziris; Piret Viiklepp; Stalz Charles Vilbrun; Kathleen Walsh; Janice Westenhouse; Wing-Wai Yew; Jae-Joon Yim; Nicola M. Zetola; Matteo Zignol; Dick Menzies; Collaborative Grp Meta-Analysis In

doi:10.1016/S0140-6736(18)31644-1

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Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis

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Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis

Nafees Ahmad, Shama D. Ahuja, Onno W. Akkerman, Jan-Willem C. Alffenaar, Laura F. Anderson, Parvaneh Baghaei, Didi Bang, Pennan M. Barry, Mayara L. Bastos, Digamber Behera, …

The Lancet (British edition), Vol.392(10150), pp.821-834

08/09/2018

DOI: https://doi.org/10.1016/S0140-6736(18)31644-1

PMID: 30215381

Résumé

General & Internal Medicine

Life Sciences & Biomedicine

Medicine, General & Internal

Science & Technology

Background Treatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis. Methods In this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library to identify potentially eligible observational and experimental studies published between Jan 1, 2009, and April 30, 2016. We also searched reference lists from all systematic reviews of treatment of multidrug-resistant tuberculosis published since 2009. To be eligible, studies had to report original results, with end of treatment outcomes (treatment completion [success], failure, or relapse) in cohorts of at least 25 adults (aged >18 years). We used anonymised individual patient data from eligible studies, provided by study investigators, regarding clinical characteristics, treatment, and outcomes. Using propensity score-matched generalised mixed effects logistic, or linear regression, we calculated adjusted odds ratios and adjusted risk differences for success or death during treatment, for specific drugs currently used to treat multidrug-resistant tuberculosis, as well as the number of drugs used and treatment duration. Findings Of 12030 patients from 25 countries in 50 studies, 7346 (61%) had treatment success, 1017 (8%) had failure or relapse, and 1729 (14%) died. Compared with failure or relapse, treatment success was positively associated with the use of linezolid (adjusted risk difference 0.15, 95% CI 0.11 to 0.18), levofloxacin (0.15, 0.13 to 0.18), carbapenems (0.14,0.06 to 0.21), moxifloxacin (0.11, 0.08 to 0.14), bedaquiline (0.10, 0.05 to 0.14), and clofazimine (0.06, 0.01 to 0.10). There was a significant association between reduced mortality and use of linezolid (-0.20, -0.23 to -0.16), levofloxacin (-0.06, -0.09 to -0.04), moxifloxacin (-0.07, -0.10 to -0.04), or bedaquiline (-0.14, -0.19 to -0.10). Compared with regimens without any injectable drug, amikacin provided modest benefits, but kanamycin and capreomycin were associated with worse outcomes. The remaining drugs were associated with slight or no improvements in outcomes. Treatment outcomes were significantly worse for most drugs if they were used despite in-vitro resistance. The optimal number of effective drugs seemed to be five in the initial phase, and four in the continuation phase. In these adjusted analyses, heterogeneity, based on a simulated I-2 method, was high for approximately half the estimates for specific drugs, although relatively low for number of drugs and durations analyses. Interpretation Although inferences are limited by the observational nature of these data, treatment outcomes were significantly better with use of linezolid, later generation fluoroquinolones, bedaquiline, clofazimine, and carbapenems for treatment of multidrug-resistant tuberculosis. These findings emphasise the need for trials to ascertain the optimal combination and duration of these drugs for treatment of this condition.

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Titre: Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis
Créateurs - sans rôle: Nafees Ahmad - Univ Baluchistan, Fac Pharm & Hlth Sci, Quetta, Pakistan
Shama D. Ahuja - New York City Dept Hlth & Mental Hyg, Bur TB Control, New York, NY 10013 USA
Onno W. Akkerman - University of Groningen
Jan-Willem C. Alffenaar - Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharm & Pharmacol, Groningen, Netherlands
Laura F. Anderson - WHO, Global TB Program, Geneva, Switzerland
Parvaneh Baghaei - Shahid Beheshti Univ Med Sci, Clin TB & Epidemiol Res Ctr, NRITLD, Tehran, Iran
Didi Bang - Statens Serum Inst, Copenhagen, Denmark
Pennan M. Barry - Calif Dept Publ Hlth, Ctr Infect Dis, Div Communicable Dis Control, TB Control Branch, Sacramento, CA USA
Mayara L. Bastos - Univ Estado Rio De Janeiro, Epidemiol Dept, Social Med Inst, Rio De Janeiro, Brazil
Digamber Behera - WHO, Collaborating Ctr Res & Capac Bldg Chron Resp Dis, Dept Pulm Med, Chandigarh, India
Andrea Benedetti - McGill Univ, Hlth Ctr, Res Inst, Montreal Chest Inst, Montreal, PQ, Canada
Gregory P. Bisson - Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA
Martin J. Boeree - Radboud Univ Nijmegen, Med Ctr Nijmegen & Dekkerswald Radboudumc, Dept Pulm Dis, Groesbeek, Netherlands
Maryline Bonnet - Epictr MSF, Paris, France
Sarah K. Brode - Univ Toronto, Univ Hlth Network, West Pk Healthcare Ctr, Dept Med,Div Respirol, Toronto, ON, Canada
James C. M. Brust - Albert Einstein Coll Med, Montefiore Med Ctr, Div Gen Internal Med, New York, NY USA
Ying Cai - NIAID, TB Res Sect, Lab Clin Immunol & Microbiol, US Natl Inst Hlth, 9000 Rockville Pike, Bethesda, MD 20892 USA
Eric Caumes - Assistance Publique – Hôpitaux de Paris
J. Peter Cegielski - Ctr Dis Control & Prevent, Div Global HIV & TB, Atlanta, GA USA
Rosella Centis - WHO, Collaborating Ctr TB & Lung Dis, Maugeri Care & Res Inst, Tradate, Italy
Pei-Chun Chan - Taiwan Ctr Dis Control, Div Chron Infect Dis, Taipei, Taiwan
Edward D. Chan - Univ Colorado Denver, Dept Med, Aurora, CO USA
Kwok-Chiu Chang - Ctr Hlth Protect, Dept Hlth, TB & Chest Serv, Hong Kong, Hong Kong, Peoples R China
Macarthur Charles - Haiti Country Off, Ctr Dis Control & Prevent, Port Au Prince, Haiti
Andra Cirule - Riga East Univ Hosp, Ctr TB & Lung Dis, Riga, Latvia
Margareth Pretti Dalcolmo - Ctr Referencia Helio Fraga, Fiocruz, Brazil
Lia D'Ambrosio - WHO, Collaborating Ctr TB & Lung Dis, Maugeri Care & Res Inst, Tradate, Italy
Gerard de Vries - Natl Inst Publ Hlth & Environm RIVM, Ctr Infect Dis Control, Bilthoven, Netherlands
Keertan Dheda - Univ Cape Town, Ctr Lung Infect & Immun, Dept Med, Cape Town, South Africa
Aliasgar Esmail
Jennifer Flood - Calif Dept Publ Hlth, Ctr Infect Dis, Div Communicable Dis Control, TB Control Branch, Sacramento, CA USA
Gregory J. Fox - Univ Sydney, Sydney Med Sch, Sydney, NSW, Australia
Mathilde Frechet-Jachym - Ctr Hosp Bligny, Briis Sous Forges, France
Geisa Fregona - Univ Fed Espirito Santo, Vitoria, Brazil
Regina Gayoso - Ctr Referencia Helio Fraga, Fiocruz, Brazil
Medea Gegia - WHO, Global TB Program, Geneva, Switzerland
Maria Tarcela Gler - Trop Dis Fdn, Manila, Philippines
Sue Gu - Univ Colorado Denver, Dept Med, Aurora, CO USA
Lorenzo Guglielmetti - Hop Univ Pitie Salpetriere Charles Foix, AP HP, Lab Bacteriol Hyg, Ctr Natl Reference Mycobacteries & Resistance Myc, Paris, France
Timothy H. Holtz - Ctr Dis Control & Prevent, Div Global HIV & TB, Atlanta, GA USA
Jennifer Hughes - Med Sans Frontieres, Khayelitsha, South Africa
Petros Isaakidis - Med Sans Frontieres, Bombay, Maharashtra, India
Leah Jarlsberg - Univ Calif San Francisco, Div Pulm & Crit Care Med, San Francisco, CA 94143 USA
Russell R. Kempker - Emory Univ, Sch Med, Div Infect Dis, Atlanta, GA USA
Salmaan Keshavjee - Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA USA
Faiz Ahmad Khan - McGill Univ, Hlth Ctr, Res Inst, Montreal Chest Inst, Montreal, PQ, Canada
Maia Kipiani - Natl Ctr TB & Lung Dis, Tbilisi, Georgia
Serena P. Koenig - Brigham & Womens Hosp, Div Global Hlth Equ, 75 Francis St, Boston, MA 02115 USA
Won-Jung Koh - Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Seoul, South Korea
Afranio Kritski - Univ Fed Rio de Janeiro, Sch Med, Acad TB Program, Rio De Janeiro, Brazil
Liga Kuksa - Riga East Univ Hosp, Dept MDR TB, Riga, Latvia
Charlotte L. Kvasnovsky - Cohen Childrens Med Ctr, Hofstra Northwell Sch Med, Div Pediat Surg, New Hyde Pk, NY USA
Nakwon Kwak - Seoul Natl Univ, Coll Med, Div Pulm & Crit Care Med, Dept Internal Med, Seoul, South Korea
Zhiyi Lan - McGill Univ, Hlth Ctr, Res Inst, Montreal Chest Inst, Montreal, PQ, Canada
Christoph Lange - Res Ctr Borstel, Div Clin Infect Dis, Sulfeld, Germany
Rafael Laniado-Laborin - Tijuana Gen Hosp, TB Clin & Lab, Tijuana, Mexico
Myungsun Lee - Int TB Res Ctr, Seoul, South Korea
Vaira Leimane - Riga East Univ Hosp, Ctr TB & Lung Dis, Riga, Latvia
Chi-Chiu Leung - Ctr Hlth Protect, Dept Hlth, TB & Chest Serv, Hong Kong, Hong Kong, Peoples R China
Eric Chung-Ching Leung - Ctr Hlth Protect, Dept Hlth, TB & Chest Serv, Hong Kong, Hong Kong, Peoples R China
Pei Zhi Li - McGill Univ, Hlth Ctr, Res Inst, Montreal Chest Inst, Montreal, PQ, Canada
Phil Lowenthal - Calif Dept Publ Hlth, Ctr Infect Dis, Div Communicable Dis Control, TB Control Branch, Sacramento, CA USA
Ethel L. Maciel - Univ Fed Espirito Santo, Vitoria, Brazil
Suzanne M. Marks - Ctr Dis Control & Prevent, Div TB Eliminat, Atlanta, GA USA
Sundari Mase - Ctr Dis Control & Prevent, Div TB Eliminat, Atlanta, GA USA
Lawrence Mbuagbaw - McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Giovanni B. Migliori - WHO, Collaborating Ctr TB & Lung Dis, Maugeri Care & Res Inst, Tradate, Italy
Vladimir Milanov - Med Univ Sofia, Med Fac, Univ Hosp Resp Dis St Sofia, Sofia, Bulgaria
Ann C. Miller - Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA USA
Carole D. Mitnick - Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA USA
Chawangwa Modongo - Botswana UPenn Partnership, Gaborone, Botswana
Erika Mohr - Med Sans Frontieres, Khayelitsha, South Africa
Ignacio Monedero - Int Union TB & Lung Dis, TB HIV Dept, Paris, France
Payam Nahid - College Station Medical Center
Norbert Ndjeka - South African Natl Dept Hlth, Natl TB Programme, Pretoria, South Africa
Max R. O'Donnell - Columbia Univ, Med Ctr, Div Pulm Allergy & Crit Care Med, New York, NY USA
Nesri Padayatchi - CAPRISA, MRC TB HIV Treatment & Pathogenesis Res Unit, Durban, South Africa
Domingo Palmero - Municipal Hosp FJ Muniz, Pulmonol Div, Buenos Aires, DF, Argentina
Jean William Pape - Haitian Study Grp Kaposis Sarcoma & Opportunist I, Port Au Prince, Haiti
Laura J. Podewils - Ctr Dis Control & Prevent, Div Global HIV & TB, Atlanta, GA USA
Ian Reynolds - Univ Colorado Denver, Dept Med, Aurora, CO USA
Vija Riekstina - Riga East Univ Hosp, Ctr TB & Lung Dis, Riga, Latvia
Jerome Robert - Assistance Publique – Hôpitaux de Paris
Maria Rodriguez - Natl TB Control Program, Santo Domingo, Dominican Rep
Barbara Seaworth - Univ Texas Hlth Sci Ctr Tyler, Heartland Natl TB Ctr, Tyler, TX USA
Kwonjune J. Seung - Partners Hlth, Boston, MA USA
Kathryn Schnippel - Univ Cape Town, Fac Hlth Sci, Sch Publ Hlth & Family Med, Cape Town, South Africa
Tae Sun Shim - Univ Ulsan, Coll Med, Dept Pulm & Crit Care Med, Seoul, South Korea
Rupak Singla - Natl Inst TB & Resp Dis, New Delhi, India
Sarah E. Smith - Ctr Dis Control & Prevent, Div Global HIV & TB, Atlanta, GA USA
Giovanni Sotgiu - University of Sassari
Ganzaya Sukhbaatar - Minist Hlth Mongolia, Ulaanbaatar, Mongolia
Payam Tabarsi - Shahid Beheshti Univ Med Sci, Clin TB & Epidemiol Res Ctr, NRITLD, Tehran, Iran
Simon Tiberi - Royal London Hosp, Barts Hlth NHS Trust, London, England
Anete Trajman - Univ Estado Rio De Janeiro, Epidemiol Dept, Social Med Inst, Rio De Janeiro, Brazil
Lisa Trieu - New York City Dept Hlth & Mental Hyg, Bur TB Control, New York, NY 10013 USA
Zarir F. Udwadia - Hinduja Hosp & Res Ctr, Bombay, Maharashtra, India
Tjip S. van der Werf - Univ Groningen, Univ Med Ctr Groningen, Dept Pulm Dis & TB, Groningen, Netherlands
Nicolas Veziris - Assistance Publique – Hôpitaux de Paris
Piret Viiklepp - Natl Inst Hlth Dev, Estonian TB Registry, Tallinn, Estonia
Stalz Charles Vilbrun - Haitian Study Grp Kaposis Sarcoma & Opportunist I, Port Au Prince, Haiti
Kathleen Walsh - Haitian Study Grp Kaposis Sarcoma & Opportunist I, Port Au Prince, Haiti
Janice Westenhouse - Calif Dept Publ Hlth, Ctr Infect Dis, Div Communicable Dis Control, TB Control Branch, Sacramento, CA USA
Wing-Wai Yew - Chinese University of Hong Kong
Jae-Joon Yim - Seoul Natl Univ, Coll Med, Div Pulm & Crit Care Med, Dept Internal Med, Seoul, South Korea
Nicola M. Zetola - Botswana UPenn Partnership, Gaborone, Botswana
Matteo Zignol - WHO, Global TB Program, Geneva, Switzerland
Dick Menzies - McGill Univ, Hlth Ctr, Res Inst, Montreal Chest Inst, Montreal, PQ, Canada
Collaborative Grp Meta-Analysis In
Détails de publication: The Lancet (British edition), Vol.392(10150), pp.821-834
Éditeur: Elsevier
Nombre de pages: 14
Note de subvention: US Centers for Disease Control and Prevention; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA American Thoracic Society European Respiratory Society Infectious Diseases Society of America Canadian Institutes of Health Research; Canadian Institutes of Health Research (CIHR)
Identifiants: 99158637809311
Unité académique: Recherches translationnelles sur le VIH et les Maladies Infect. Endém. émerg. - TransVIHMI
Langue: English
Type de ressource: Journal article