Tea Madzgharashvili1, Argita D Salindri2, Matthew J Magee3,4, Nestani Tukvadze1, Zaza Avaliani1, Henry M Blumberg3,4,5, Russell R Kempker5, Nino Lomtadze1. 1. National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia. 2. Department of Population Health Sciences, Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA. 3. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. 4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. 5. Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, USA.
Abstract
BACKGROUND: Among pediatric patients with multidrug-resistant tuberculosis (MDR-TB), limited data exist regarding treatment outcomes in the context of the new and repurposed second-line TB drugs (SLDs). We aimed to describe the treatment outcomes among pediatric MDR-TB patients receiving new and repurposed SLDs including the proportion who achieved favorable outcomes. METHODS: We conducted a retrospective cohort study among pediatric patients (age ≤18 years) treated for MDR-TB in the country of Georgia from 2009 to 2016. A "new and repurposed" SLD regimen was defined as a regimen that included linezolid, bedaquiline, and/or delamanid. Favorable treatment outcome was defined by treatment completion or documented microbial "cure" status at the end of treatment. We assessed the association between the use of the new and repurposed SLDs with MDR-TB treatment outcomes using bivariate analyses and log-binomial regression. RESULTS: There were 124 pediatric MDR-TB patients (median age: 13.7; interquartile range: 4.6-16.0) initiating treatment; 119 (96.0%) had a treatment outcome recorded and were included in our analyses. Eighteen (15.1%) patients received new and repurposed SLDs from 2015 or later. After adjusting for potential confounders, the proportion achieving favorable MDR-TB treatment outcomes was higher among patients treated with SLD regimens that included new and/or repurposed drugs when compared with those treated without (adjusted risk ratio: 1.17; 95% confidence interval: 0.51-2.72). CONCLUSIONS: We observed a high proportion of favorable treatment outcomes among pediatric patients with MDR-TB receiving the new and repurposed SLDs. Further studies to evaluate the efficacy and children's tolerability of the new and repurposed SLDs are still warranted.
BACKGROUND: Among pediatric patients with multidrug-resistant tuberculosis (MDR-TB), limited data exist regarding treatment outcomes in the context of the new and repurposed second-line TB drugs (SLDs). We aimed to describe the treatment outcomes among pediatric MDR-TB patients receiving new and repurposed SLDs including the proportion who achieved favorable outcomes. METHODS: We conducted a retrospective cohort study among pediatric patients (age ≤18 years) treated for MDR-TB in the country of Georgia from 2009 to 2016. A "new and repurposed" SLD regimen was defined as a regimen that included linezolid, bedaquiline, and/or delamanid. Favorable treatment outcome was defined by treatment completion or documented microbial "cure" status at the end of treatment. We assessed the association between the use of the new and repurposed SLDs with MDR-TB treatment outcomes using bivariate analyses and log-binomial regression. RESULTS: There were 124 pediatric MDR-TB patients (median age: 13.7; interquartile range: 4.6-16.0) initiating treatment; 119 (96.0%) had a treatment outcome recorded and were included in our analyses. Eighteen (15.1%) patients received new and repurposed SLDs from 2015 or later. After adjusting for potential confounders, the proportion achieving favorable MDR-TB treatment outcomes was higher among patients treated with SLD regimens that included new and/or repurposed drugs when compared with those treated without (adjusted risk ratio: 1.17; 95% confidence interval: 0.51-2.72). CONCLUSIONS: We observed a high proportion of favorable treatment outcomes among pediatric patients with MDR-TB receiving the new and repurposed SLDs. Further studies to evaluate the efficacy and children's tolerability of the new and repurposed SLDs are still warranted.
Authors: R R Kempker; L Mikiashvili; Y Zhao; D Benkeser; K Barbakadze; N Bablishvili; Z Avaliani; C A Peloquin; H M Blumberg; M Kipiani Journal: Clin Infect Dis Date: 2020-12-03 Impact factor: 9.079
Authors: Elizabeth P Harausz; Anthony J Garcia-Prats; Stephanie Law; H Simon Schaaf; Tamara Kredo; James A Seddon; Dick Menzies; Anna Turkova; Jay Achar; Farhana Amanullah; Pennan Barry; Mercedes Becerra; Edward D Chan; Pei Chun Chan; Domnica Ioana Chiotan; Aldo Crossa; Peter C Drobac; Lee Fairlie; Dennis Falzon; Jennifer Flood; Medea Gegia; Robert M Hicks; Petros Isaakidis; S M Kadri; Beate Kampmann; Shabir A Madhi; Else Marais; Andrei Mariandyshev; Ana Méndez-Echevarría; Brittany Kathryn Moore; Parpieva Nargiza; Iveta Ozere; Nesri Padayatchi; Saleem- Ur-Rehman; Natasha Rybak; Begoña Santiago-Garcia; N Sarita Shah; Sangeeta Sharma; Tae Sun Shim; Alena Skrahina; Antoni Soriano-Arandes; Martin van den Boom; Marieke J van der Werf; Tjip S van der Werf; Bhanu Williams; Elena Yablokova; Jae-Joon Yim; Jennifer Furin; Anneke C Hesseling Journal: PLoS Med Date: 2018-07-11 Impact factor: 11.069