N Alipanah1, A Cattamanchi1, R Menzies2, P C Hopewell1, R E Chaisson3, P Nahid1. 1. Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA. 2. Montreal Chest Institute, McGill University, Montreal, Quebec, Canada. 3. Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Abstract
SETTING: Several recent trials evaluating 4-month fluoroquinolone (FQ) containing regimens found that none of the experimental regimens were non-inferior to standard 6-month therapy in treating patients with drug-susceptible pulmonary tuberculosis (PTB). OBJECTIVE: To answer whether FQ-containing duration-shortened regimens are non-inferior to standard therapy in the treatment of patients with non-cavitary PTB. DESIGN: Systematic review of all randomized and quasi-randomized trials that substituted an FQ into standard therapy for less than 6 months' duration to treat drug-susceptible, non-cavitary PTB. Non-inferiority was based on a 6% margin of difference. RESULTS: Of 4594 total participants in the three trials that met the inclusion criteria, 1066 patients had non-cavitary disease. The pooled difference in unfavorable outcomes was 5% (95%CI -3 to 13) in patients with non-cavitary disease treated with FQ-containing regimens vs. standard therapy. In subgroup analyses, the pooled difference in unfavorable outcomes was 1% (95%CI -3 to 5) when comparing the daily form of intervention regimen with standard therapy, and -1% (95%CI -5 to 4) between regimens replacing ethambutol (EMB) with an FQ and standard therapy. No difference in risk of adverse events was noted. CONCLUSION: Daily administered 4-month regimens with substitution of EMB by an FQ may be non-inferior to standard therapy in patients with culture-confirmed, non-cavitary, drug-susceptible PTB.
SETTING: Several recent trials evaluating 4-month fluoroquinolone (FQ) containing regimens found that none of the experimental regimens were non-inferior to standard 6-month therapy in treating patients with drug-susceptible pulmonary tuberculosis (PTB). OBJECTIVE: To answer whether FQ-containing duration-shortened regimens are non-inferior to standard therapy in the treatment of patients with non-cavitary PTB. DESIGN: Systematic review of all randomized and quasi-randomized trials that substituted an FQ into standard therapy for less than 6 months' duration to treat drug-susceptible, non-cavitary PTB. Non-inferiority was based on a 6% margin of difference. RESULTS: Of 4594 total participants in the three trials that met the inclusion criteria, 1066 patients had non-cavitary disease. The pooled difference in unfavorable outcomes was 5% (95%CI -3 to 13) in patients with non-cavitary disease treated with FQ-containing regimens vs. standard therapy. In subgroup analyses, the pooled difference in unfavorable outcomes was 1% (95%CI -3 to 5) when comparing the daily form of intervention regimen with standard therapy, and -1% (95%CI -5 to 4) between regimens replacing ethambutol (EMB) with an FQ and standard therapy. No difference in risk of adverse events was noted. CONCLUSION: Daily administered 4-month regimens with substitution of EMB by an FQ may be non-inferior to standard therapy in patients with culture-confirmed, non-cavitary, drug-susceptible PTB.
Authors: Alfonso C Hernandez-Romieu; Brent P Little; Adam Bernheim; Marcos C Schechter; Susan M Ray; Destani Bizune; Russell Kempker Journal: Open Forum Infect Dis Date: 2019-06-24 Impact factor: 3.835
Authors: Patrick P J Phillips; Carole D Mitnick; James D Neaton; Payam Nahid; Christian Lienhardt; Andrew J Nunn Journal: PLoS Med Date: 2019-03-22 Impact factor: 11.069
Authors: Marjorie Z Imperial; Payam Nahid; Patrick P J Phillips; Geraint R Davies; Katherine Fielding; Debra Hanna; David Hermann; Robert S Wallis; John L Johnson; Christian Lienhardt; Rada M Savic Journal: Nat Med Date: 2018-11-05 Impact factor: 53.440