U Ateba-Ngoa1,2, J R Edoa1,2, B R Adegbite1,2, E G Rossatanga3, D Madiou3, A Mfoumbi1, C Mevyann1, P Achimi Agbo1, J Mahoumbou4, S Gould1, B Lell1,2, A A Adegnika1,2, C Köhler1,2, P G Kremsner1,2, M Massinga-Loembe1,2, A Alabi1,2, M P Grobusch5,6,7. 1. Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon. 2. Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany. 3. Centre Hospitalier Régional Georges Rawiri de Lambaréné, Lambarene, Gabon. 4. Programme National de Lutte contre la Tuberculose, Ministry of Health, Libreville, Gabon. 5. Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon. m.p.grobusch@amsterdamumc.nl. 6. Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany. m.p.grobusch@amsterdamumc.nl. 7. Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands. m.p.grobusch@amsterdamumc.nl.
Abstract
PURPOSE: Since May 2016, WHO recommended a 9-12 month short-treatment regimen for multidrug-resistant tuberculosis (MDR-TB) treatment known as the 'Bangladesh Regimen'. However, limited data exist on the appropriateness thereof, and its implementation in low- and middle-income countries (LMIC). We report here on the pilot phase of the evaluation of the Bangladesh regimen in Gabon, prior to its endorsement by the WHO. METHODS: This ongoing observational study started in September 2015. Intensive training of hospital health workers as well as community information and education were conducted. GeneXpert-confirmed MDR-TB patients received the second-line anti-tuberculosis drugs (4KmMfxPtoHCfzEZ/5MfxCfzEZ). Sputum smears and cultures were done monthly. Adverse events were monitored daily. RESULTS: Eleven patients have been treated for MDR-TB piloting the short regimen. All were HIV-negative and presented in poor health with extensive pulmonary lesions. The overall sputum culture conversion rate was 64% after 4 months of treatment. Three patients developed marked hearing loss; one a transient cutaneous rash. Of 11 patients in our continuous care, 7 (63.6%) significantly improved clinically and bacteriologically. One (9.1%) patient experienced a treatment failure, two (18.2%) died, and one (9.1%) was lost to follow up. CONCLUSIONS: Our pioneering data on systematic MDR-TB treatment in Gabon, with currently almost total absence of resistance against the second-line drugs, demonstrate that a 9-month regimen has the capacity to facilitate early culture negativity and sustained clinical improvement. Close adverse events monitoring and continuous care are vital to success.
PURPOSE: Since May 2016, WHO recommended a 9-12 month short-treatment regimen for multidrug-resistant tuberculosis (MDR-TB) treatment known as the 'Bangladesh Regimen'. However, limited data exist on the appropriateness thereof, and its implementation in low- and middle-income countries (LMIC). We report here on the pilot phase of the evaluation of the Bangladesh regimen in Gabon, prior to its endorsement by the WHO. METHODS: This ongoing observational study started in September 2015. Intensive training of hospital health workers as well as community information and education were conducted. GeneXpert-confirmed MDR-TBpatients received the second-line anti-tuberculosis drugs (4KmMfxPtoHCfzEZ/5MfxCfzEZ). Sputum smears and cultures were done monthly. Adverse events were monitored daily. RESULTS: Eleven patients have been treated for MDR-TB piloting the short regimen. All were HIV-negative and presented in poor health with extensive pulmonary lesions. The overall sputum culture conversion rate was 64% after 4 months of treatment. Three patients developed marked hearing loss; one a transient cutaneous rash. Of 11 patients in our continuous care, 7 (63.6%) significantly improved clinically and bacteriologically. One (9.1%) patient experienced a treatment failure, two (18.2%) died, and one (9.1%) was lost to follow up. CONCLUSIONS: Our pioneering data on systematic MDR-TB treatment in Gabon, with currently almost total absence of resistance against the second-line drugs, demonstrate that a 9-month regimen has the capacity to facilitate early culture negativity and sustained clinical improvement. Close adverse events monitoring and continuous care are vital to success.
Authors: D Mounguengui; M Ondounda; J M Mandji Lawson; M Fabre; L Gaudong; L Mangouka; C Magne; J R Nzenze; P L'her Journal: Bull Soc Pathol Exot Date: 2011-12-14
Authors: Sabine Bélard; Jonathan Remppis; Sanne Bootsma; Saskia Janssen; Davy U Kombila; Justin O Beyeme; Elie G Rossatanga; Cosme Kokou; Kara K Osbak; Régis M Obiang Mba; Harry M Kaba; Afsatou N Traoré; Jonas Ehrhardt; Emmanuel B Bache; Arnaud Flamen; Sabine Rüsch-Gerdes; Matthias Frank; Ayôla A Adegnika; Bertrand Lell; Stefan Niemann; Peter G Kremsner; Marguerite M Loembé; Abraham S Alabi; Martin P Grobusch Journal: Am J Trop Med Hyg Date: 2016-06-27 Impact factor: 2.345
Authors: Sabine Bélard; Saskia Janssen; Kara K Osbak; Ayola A Adegnika; Magloire Ondounda; Martin P Grobusch Journal: J Public Health (Oxf) Date: 2014-12-19 Impact factor: 2.341
Authors: Christoph Lange; Raquel Duarte; Mathilde Fréchet-Jachym; Gunar Guenther; Lorenzo Guglielmetti; Ioana D Olaru; Olena Oliveira; Rudolf Rumetshofer; Nicolas Veziris; Frank van Leth Journal: Am J Respir Crit Care Med Date: 2016-10-15 Impact factor: 21.405
Authors: Kathryn Schnippel; Sydney Rosen; Kate Shearer; Neil Martinson; Lawrence Long; Ian Sanne; Ebrahim Variava Journal: Trop Med Int Health Date: 2012-11-21 Impact factor: 2.622
Authors: Matteo Zignol; Anna S Dean; Dennis Falzon; Wayne van Gemert; Abigail Wright; Armand van Deun; Françoise Portaels; Adalbert Laszlo; Marcos A Espinal; Ariel Pablos-Méndez; Amy Bloom; Mohamed A Aziz; Karin Weyer; Ernesto Jaramillo; Paul Nunn; Katherine Floyd; Mario C Raviglione Journal: N Engl J Med Date: 2016-09-15 Impact factor: 91.245
Authors: Anja Vigenschow; Bayodé Romeo Adegbite; Jean-Ronald Edoa; Abraham Alabi; Akim A Adegnika; Martin P Grobusch; Marguerite Massinga-Loembe Journal: BMC Health Serv Res Date: 2021-11-05 Impact factor: 2.655
Authors: B R Adegbite; J R Edoa; Jbp Agbo Achimi Abdul; M Epola; C Mevyann; J C Dejon-Agobé; J F Zinsou; Y J Honkpehedji; S G Mpagama; A S Alabi; P G Kremsner; K Klipstein-Grobusch; A A Adegnika; M P Grobusch Journal: EClinicalMedicine Date: 2022-02-27