Faiz Ahmad Khan1, Irina Y Gelmanova2, Molly F Franke3, Sidney Atwood4, Nataliya A Zemlyanaya5, Irina A Unakova6, Yevgeniy G Andreev6, Valentina I Berezina7, Vera E Pavlova7, Sonya S Shin8, Askar B Yedilbayev9, Mercedes C Becerra10, Salmaan Keshavjee10. 1. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts Respiratory Epidemiology and Clinical Research Unit & McGill International TB Centre, McGill University, Montreal, Quebec, Canada. 2. Partners In Health Russia, Moscow, Russian Federation. 3. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. 4. Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. 5. Partners In Health Russia, Moscow, Russian Federation Siberian State Medical University. 6. Tomsk Penitentiary Services, Ministry of Justice. 7. Tomsk Oblast Tuberculosis Services, Russian Federation. 8. Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts Partners In Health, Boston, Massachusetts. 9. Partners In Health, Boston, Massachusetts. 10. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts Partners In Health, Boston, Massachusetts.
Abstract
BACKGROUND: We sought to determine whether treatment with a "long aggressive regimen" was associated with lower rates of relapse among patients successfully treated for pulmonary multidrug-resistant tuberculosis (MDR-TB) in Tomsk, Russia. METHODS: We conducted a retrospective cohort study of adult patients that initiated MDR-TB treatment with individualized regimens between September 2000 and November 2004, and were successfully treated. Patients were classified as having received "aggressive regimens" if their intensive phase consisted of at least 5 likely effective drugs (including a second-line injectable and a fluoroquinolone) used for at least 6 months post culture conversion, and their continuation phase included at least 4 likely effective drugs. Patients that were treated with aggressive regimens for a minimum duration of 18 months post culture conversion were classified as having received "long aggressive regimens." We used recurrence as a proxy for relapse because genotyping was not performed. After treatment, patients were classified as having disease recurrence if cultures grew MDR-TB or they re-initiated MDR-TB therapy. Data were analyzed using Cox proportional hazard regression. RESULTS: Of 408 successfully treated patients, 399 (97.5%) with at least 1 follow-up visit were included. Median duration of follow-up was 42.4 months (interquartile range: 20.5-59.5), and there were 27 recurrence episodes. In a multivariable complete case analysis (n = 371 [92.9%]) adjusting for potential confounders, long aggressive regimens were associated with a lower rate of recurrence (adjusted hazard ratio: 0.22, 95% confidence interval, .05-.92). CONCLUSIONS: Long aggressive regimens for MDR-TB treatment are associated with lower risk of disease recurrence.
BACKGROUND: We sought to determine whether treatment with a "long aggressive regimen" was associated with lower rates of relapse among patients successfully treated for pulmonary multidrug-resistant tuberculosis (MDR-TB) in Tomsk, Russia. METHODS: We conducted a retrospective cohort study of adult patients that initiated MDR-TB treatment with individualized regimens between September 2000 and November 2004, and were successfully treated. Patients were classified as having received "aggressive regimens" if their intensive phase consisted of at least 5 likely effective drugs (including a second-line injectable and a fluoroquinolone) used for at least 6 months post culture conversion, and their continuation phase included at least 4 likely effective drugs. Patients that were treated with aggressive regimens for a minimum duration of 18 months post culture conversion were classified as having received "long aggressive regimens." We used recurrence as a proxy for relapse because genotyping was not performed. After treatment, patients were classified as having disease recurrence if cultures grew MDR-TB or they re-initiated MDR-TB therapy. Data were analyzed using Cox proportional hazard regression. RESULTS: Of 408 successfully treated patients, 399 (97.5%) with at least 1 follow-up visit were included. Median duration of follow-up was 42.4 months (interquartile range: 20.5-59.5), and there were 27 recurrence episodes. In a multivariable complete case analysis (n = 371 [92.9%]) adjusting for potential confounders, long aggressive regimens were associated with a lower rate of recurrence (adjusted hazard ratio: 0.22, 95% confidence interval, .05-.92). CONCLUSIONS: Long aggressive regimens for MDR-TB treatment are associated with lower risk of disease recurrence.
Authors: A M W Efsen; A Schultze; R F Miller; A Panteleev; A Skrahin; D N Podlekareva; J M Miro; E Girardi; H Furrer; M H Losso; J Toibaro; J A Caylà; A Mocroft; J D Lundgren; F A Post; O Kirk Journal: J Infect Date: 2017-10-20 Impact factor: 6.072
Authors: Phillip P Salvatore; Emily A Kendall; Dena Seabrook; Jessie Brown; George H Durham; David W Dowdy Journal: Sci Rep Date: 2019-12-02 Impact factor: 4.379