Samuel Kasozi1, Justin Clark2, Suhail A R Doi3. 1. National Tuberculosis and Leprosy Control Program, Ministry of Health, Wandegeya, Uganda School of Public Health, Makerere University, Uganda School of Population Health, University of Queensland, Brisbane, Australia drsamuelkasozi@gmail.com. 2. Australian Catholic University Library, Brisbane, Australia Research School of Population Health, Australian National University, Canberra, Australia. 3. School of Population Health, University of Queensland, Brisbane, Australia.
Abstract
BACKGROUND: Several systematic reviews suggest that intermittent pulmonary tuberculosis (TB) chemotherapy is effective, but intensity (daily versus intermittent) and duration of rifampicin use (intensive phase only versus both phases) have not been distinguished. In addition, the various outcomes (success, failure, relapse, and default) have only selectively been evaluated. METHODS: We conducted a meta-analysis of proportions using all four outcomes as multi-category proportions to examine the effectiveness of WHO category 1 TB treatment regimens. Database searches of studies reporting treatment outcomes of HIV negative subjects were included and stratified by intensity of therapy and duration of rifampicin therapy. Using a bias-adjusted statistical model, we pooled proportions of the four treatment outcome categories using a method that handles multi-category proportions. RESULTS: A total of 27 studies comprising of 48 data sets with 10,624 participants were studied. Overall, treatment success was similar among patients treated with intermittent (I/I) (88%) (95% CI, 81-92) and daily (D/D) (90%) (95% CI, 84-95) regimens. Default was significantly less with I/I (0%) (95% CI, 0-2) compared to D/D regimens (5%) (95% CI, 1-9). Nevertheless, I/I relapse rates (7%) (95% CI, 3-11) were higher than D/D relapse rates (1%) (95% CI, 0-3). CONCLUSION: Treatment regimens that are offered completely intermittently versus completely daily are associated with a trade-off between treatment relapse and treatment default. There is a possibility that I/I regimens can be improved by increasing treatment duration, and this needs to be urgently addressed by future studies.
BACKGROUND: Several systematic reviews suggest that intermittent pulmonary tuberculosis (TB) chemotherapy is effective, but intensity (daily versus intermittent) and duration of rifampicin use (intensive phase only versus both phases) have not been distinguished. In addition, the various outcomes (success, failure, relapse, and default) have only selectively been evaluated. METHODS: We conducted a meta-analysis of proportions using all four outcomes as multi-category proportions to examine the effectiveness of WHO category 1 TB treatment regimens. Database searches of studies reporting treatment outcomes of HIV negative subjects were included and stratified by intensity of therapy and duration of rifampicin therapy. Using a bias-adjusted statistical model, we pooled proportions of the four treatment outcome categories using a method that handles multi-category proportions. RESULTS: A total of 27 studies comprising of 48 data sets with 10,624 participants were studied. Overall, treatment success was similar among patients treated with intermittent (I/I) (88%) (95% CI, 81-92) and daily (D/D) (90%) (95% CI, 84-95) regimens. Default was significantly less with I/I (0%) (95% CI, 0-2) compared to D/D regimens (5%) (95% CI, 1-9). Nevertheless, I/I relapse rates (7%) (95% CI, 3-11) were higher than D/D relapse rates (1%) (95% CI, 0-3). CONCLUSION: Treatment regimens that are offered completely intermittently versus completely daily are associated with a trade-off between treatment relapse and treatment default. There is a possibility that I/I regimens can be improved by increasing treatment duration, and this needs to be urgently addressed by future studies.
Authors: J H Perriëns; M E St Louis; Y B Mukadi; C Brown; J Prignot; F Pouthier; F Portaels; J C Willame; J K Mandala; M Kaboto Journal: N Engl J Med Date: 1995-03-23 Impact factor: 91.245
Authors: Salla A Munro; Simon A Lewin; Helen J Smith; Mark E Engel; Atle Fretheim; Jimmy Volmink Journal: PLoS Med Date: 2007-07-24 Impact factor: 11.069
Authors: Dick Menzies; Andrea Benedetti; Anita Paydar; Ian Martin; Sarah Royce; Madhukar Pai; Andrew Vernon; Christian Lienhardt; William Burman Journal: PLoS Med Date: 2009-09-15 Impact factor: 11.069
Authors: Nicholas Sebuliba Kirirabwa; Derrick Kimuli; Carol Nanziri; Denis Sama; Syrus Ntudhu; Daniel Ayen Okello; Raymond Byaruhanga; Deus Lukoye; Samuel Kasozi Journal: BMC Pulm Med Date: 2019-05-10 Impact factor: 3.317
Authors: Brenda Crabtree-Ramirez; Cathy A Jenkins; Bryan E Shepherd; Karu Jayathilake; Valdilea G Veloso; Gabriela Carriquiry; Eduardo Gotuzzo; Claudia P Cortes; Dennis Padgett; Catherine McGowan; Juan Sierra-Madero; Serena Koenig; Jean W Pape; Timothy R Sterling Journal: BMC Infect Dis Date: 2022-04-05 Impact factor: 3.667
Authors: Richard S Garfein; Lin Liu; Jazmine Cuevas-Mota; Kelly Collins; Fatima Muñoz; Donald G Catanzaro; Kathleen Moser; Julie Higashi; Teeb Al-Samarrai; Paula Kriner; Julie Vaishampayan; Javier Cepeda; Michelle A Bulterys; Natasha K Martin; Phillip Rios; Fredric Raab Journal: Emerg Infect Dis Date: 2018-10 Impact factor: 6.883