Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis

Syed Abidi; Jay Achar; Mourtala Mohamed Assao Neino; Didi Bang; Andrea Benedetti; Sarah Brode; Jonathon R. Campbell; Esther C. Casas; Francesca Conradie; Gunta Dravniece; Philipp du Cros; Dennis Falzon; Ernesto Jaramillo; Christopher Kuaban; Zhiyi Lan; Christoph Lange; Pei Zhi Li; Mavluda Makhmudova; Aung Kya Jai Maug; Dick Menzies; Giovanni Battista Migliori; Ann Miller; Bakyt Myrzaliev; Norbert Ndjeka; Jürgen Noeske; Nargiza Parpieva; Alberto Piubello; Valérie Schwoebel; Welile Sikhondze; Rupak Singla; Mahamadou Bassirou Souleymane; Arnaud Trébucq; Armand van Deun; Kerri Viney; Karin Weyer; Betty Jingxuan Zhang; Faiz Ahmad Khan

doi:10.1183/13993003.01467-2019

Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis

Syed Abidi, Jay Achar, Mourtala Mohamed Assao Neino, Didi Bang, Andrea Benedetti, Sarah Brode, Jonathon R. Campbell, Esther C. Casas, Francesca Conradie, Gunta Dravniece, Philipp du Cros, Dennis Falzon, Ernesto Jaramillo, Christopher Kuaban, Zhiyi Lan, Christoph Lange, Pei Zhi Li, Mavluda Makhmudova, Aung Kya Jai Maug, Dick MenziesGiovanni Battista Migliori, Ann Miller, Bakyt Myrzaliev, Norbert Ndjeka, Jürgen Noeske, Nargiza Parpieva, Alberto Piubello, Valérie Schwoebel, Welile Sikhondze, Rupak Singla, Mahamadou Bassirou Souleymane, Arnaud Trébucq, Armand van Deun, Kerri Viney, Karin Weyer, Betty Jingxuan Zhang, Faiz Ahmad Khan^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

57 Citations (Scopus)

Abstract

We sought to compare the effectiveness of two World Health Organization (WHO)recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis (TB): a standardised regimen of 9–12 months (the “shorter regimen”) and individualised regimens of ≥20 months (“longer regimens”). We collected individual patient data from observational studies identified through systematic reviews and a public call for data. We included patients meeting WHO eligibility criteria for the shorter regimen: not previously treated with second-line drugs, and with fluoroquinolone- and second-line injectable agent-susceptible RR/MDR-TB. We used propensity score matched, mixed effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRDs) for failure or relapse, death within 12 months of treatment initiation and loss to follow-up. We included 2625 out of 3378 (77.7%) individuals from nine studies of shorter regimens and 2717 out of 13104 (20.7%) individuals from 53 studies of longer regimens. Treatment success was higher with the shorter regimen than with longer regimens (pooled proportions 80.0% versus 75.3%), due to less loss to follow-up with the former (aRD −0.15, 95% CI −0.17–−0.12). The risk difference for failure or relapse was slightly higher with the shorter regimen overall (aRD 0.02, 95% CI 0–0.05) and greater in magnitude with baseline resistance to pyrazinamide (aRD 0.12, 95% CI 0.07–0.16), prothionamide/ethionamide (aRD 0.07, 95% CI −0.01–0.16) or ethambutol (aRD 0.09, 95% CI 0.04–0.13). In patients meeting WHO criteria for its use, the standardised shorter regimen was associated with substantially less loss to follow-up during treatment compared with individualised longer regimens and with more failure or relapse in the presence of resistance to component medications. Our findings support the need to improve access to reliable drug susceptibility testing.

Original language	English
Article number	1901467
Journal	European Respiratory Journal
Volume	55
Issue number	3
DOIs	https://doi.org/10.1183/13993003.01467-2019
Publication status	Published - 1 Mar 2020

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Abidi, S., Achar, J., Assao Neino, M. M., Bang, D., Benedetti, A., Brode, S., Campbell, J. R., Casas, E. C., Conradie, F., Dravniece, G., du Cros, P., Falzon, D., Jaramillo, E., Kuaban, C., Lan, Z., Lange, C., Li, P. Z., Makhmudova, M., Jai Maug, A. K., ... Khan, F. A. (2020). Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis. European Respiratory Journal, 55(3), Article 1901467. https://doi.org/10.1183/13993003.01467-2019

@article{338681e8715448d69291e660bcd48944,

title = "Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis",

abstract = "We sought to compare the effectiveness of two World Health Organization (WHO)recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis (TB): a standardised regimen of 9–12 months (the “shorter regimen”) and individualised regimens of ≥20 months (“longer regimens”). We collected individual patient data from observational studies identified through systematic reviews and a public call for data. We included patients meeting WHO eligibility criteria for the shorter regimen: not previously treated with second-line drugs, and with fluoroquinolone- and second-line injectable agent-susceptible RR/MDR-TB. We used propensity score matched, mixed effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRDs) for failure or relapse, death within 12 months of treatment initiation and loss to follow-up. We included 2625 out of 3378 (77.7%) individuals from nine studies of shorter regimens and 2717 out of 13104 (20.7%) individuals from 53 studies of longer regimens. Treatment success was higher with the shorter regimen than with longer regimens (pooled proportions 80.0% versus 75.3%), due to less loss to follow-up with the former (aRD −0.15, 95% CI −0.17–−0.12). The risk difference for failure or relapse was slightly higher with the shorter regimen overall (aRD 0.02, 95% CI 0–0.05) and greater in magnitude with baseline resistance to pyrazinamide (aRD 0.12, 95% CI 0.07–0.16), prothionamide/ethionamide (aRD 0.07, 95% CI −0.01–0.16) or ethambutol (aRD 0.09, 95% CI 0.04–0.13). In patients meeting WHO criteria for its use, the standardised shorter regimen was associated with substantially less loss to follow-up during treatment compared with individualised longer regimens and with more failure or relapse in the presence of resistance to component medications. Our findings support the need to improve access to reliable drug susceptibility testing.",

author = "Syed Abidi and Jay Achar and {Assao Neino}, {Mourtala Mohamed} and Didi Bang and Andrea Benedetti and Sarah Brode and Campbell, {Jonathon R.} and Casas, {Esther C.} and Francesca Conradie and Gunta Dravniece and {du Cros}, Philipp and Dennis Falzon and Ernesto Jaramillo and Christopher Kuaban and Zhiyi Lan and Christoph Lange and Li, {Pei Zhi} and Mavluda Makhmudova and {Jai Maug}, {Aung Kya} and Dick Menzies and Migliori, {Giovanni Battista} and Ann Miller and Bakyt Myrzaliev and Norbert Ndjeka and J{\"u}rgen Noeske and Nargiza Parpieva and Alberto Piubello and Val{\'e}rie Schwoebel and Welile Sikhondze and Rupak Singla and Souleymane, {Mahamadou Bassirou} and Arnaud Tr{\'e}bucq and {van Deun}, Armand and Kerri Viney and Karin Weyer and Zhang, {Betty Jingxuan} and Khan, {Faiz Ahmad}",

note = "Publisher Copyright: {\textcopyright}ERS 2020.",

year = "2020",

month = mar,

day = "1",

doi = "10.1183/13993003.01467-2019",

language = "English",

volume = "55",

journal = "European Respiratory Journal",

issn = "0903-1936",

publisher = "European Respiratory Society",

number = "3",

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Abidi, S, Achar, J, Assao Neino, MM, Bang, D, Benedetti, A, Brode, S, Campbell, JR, Casas, EC, Conradie, F, Dravniece, G, du Cros, P, Falzon, D, Jaramillo, E, Kuaban, C, Lan, Z, Lange, C, Li, PZ, Makhmudova, M, Jai Maug, AK, Menzies, D, Migliori, GB, Miller, A, Myrzaliev, B, Ndjeka, N, Noeske, J, Parpieva, N, Piubello, A, Schwoebel, V, Sikhondze, W, Singla, R, Souleymane, MB, Trébucq, A, van Deun, A, Viney, K, Weyer, K, Zhang, BJ & Khan, FA 2020, 'Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis', European Respiratory Journal, vol. 55, no. 3, 1901467. https://doi.org/10.1183/13993003.01467-2019

TY - JOUR

T1 - Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis

AU - Abidi, Syed

AU - Achar, Jay

AU - Assao Neino, Mourtala Mohamed

AU - Bang, Didi

AU - Benedetti, Andrea

AU - Brode, Sarah

AU - Campbell, Jonathon R.

AU - Casas, Esther C.

AU - Conradie, Francesca

AU - Dravniece, Gunta

AU - du Cros, Philipp

AU - Falzon, Dennis

AU - Jaramillo, Ernesto

AU - Kuaban, Christopher

AU - Lan, Zhiyi

AU - Lange, Christoph

AU - Li, Pei Zhi

AU - Makhmudova, Mavluda

AU - Jai Maug, Aung Kya

AU - Menzies, Dick

AU - Migliori, Giovanni Battista

AU - Miller, Ann

AU - Myrzaliev, Bakyt

AU - Ndjeka, Norbert

AU - Noeske, Jürgen

AU - Parpieva, Nargiza

AU - Piubello, Alberto

AU - Schwoebel, Valérie

AU - Sikhondze, Welile

AU - Singla, Rupak

AU - Souleymane, Mahamadou Bassirou

AU - Trébucq, Arnaud

AU - van Deun, Armand

AU - Viney, Kerri

AU - Weyer, Karin

AU - Zhang, Betty Jingxuan

AU - Khan, Faiz Ahmad

PY - 2020/3/1

Y1 - 2020/3/1

N2 - We sought to compare the effectiveness of two World Health Organization (WHO)recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis (TB): a standardised regimen of 9–12 months (the “shorter regimen”) and individualised regimens of ≥20 months (“longer regimens”). We collected individual patient data from observational studies identified through systematic reviews and a public call for data. We included patients meeting WHO eligibility criteria for the shorter regimen: not previously treated with second-line drugs, and with fluoroquinolone- and second-line injectable agent-susceptible RR/MDR-TB. We used propensity score matched, mixed effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRDs) for failure or relapse, death within 12 months of treatment initiation and loss to follow-up. We included 2625 out of 3378 (77.7%) individuals from nine studies of shorter regimens and 2717 out of 13104 (20.7%) individuals from 53 studies of longer regimens. Treatment success was higher with the shorter regimen than with longer regimens (pooled proportions 80.0% versus 75.3%), due to less loss to follow-up with the former (aRD −0.15, 95% CI −0.17–−0.12). The risk difference for failure or relapse was slightly higher with the shorter regimen overall (aRD 0.02, 95% CI 0–0.05) and greater in magnitude with baseline resistance to pyrazinamide (aRD 0.12, 95% CI 0.07–0.16), prothionamide/ethionamide (aRD 0.07, 95% CI −0.01–0.16) or ethambutol (aRD 0.09, 95% CI 0.04–0.13). In patients meeting WHO criteria for its use, the standardised shorter regimen was associated with substantially less loss to follow-up during treatment compared with individualised longer regimens and with more failure or relapse in the presence of resistance to component medications. Our findings support the need to improve access to reliable drug susceptibility testing.

AB - We sought to compare the effectiveness of two World Health Organization (WHO)recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis (TB): a standardised regimen of 9–12 months (the “shorter regimen”) and individualised regimens of ≥20 months (“longer regimens”). We collected individual patient data from observational studies identified through systematic reviews and a public call for data. We included patients meeting WHO eligibility criteria for the shorter regimen: not previously treated with second-line drugs, and with fluoroquinolone- and second-line injectable agent-susceptible RR/MDR-TB. We used propensity score matched, mixed effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRDs) for failure or relapse, death within 12 months of treatment initiation and loss to follow-up. We included 2625 out of 3378 (77.7%) individuals from nine studies of shorter regimens and 2717 out of 13104 (20.7%) individuals from 53 studies of longer regimens. Treatment success was higher with the shorter regimen than with longer regimens (pooled proportions 80.0% versus 75.3%), due to less loss to follow-up with the former (aRD −0.15, 95% CI −0.17–−0.12). The risk difference for failure or relapse was slightly higher with the shorter regimen overall (aRD 0.02, 95% CI 0–0.05) and greater in magnitude with baseline resistance to pyrazinamide (aRD 0.12, 95% CI 0.07–0.16), prothionamide/ethionamide (aRD 0.07, 95% CI −0.01–0.16) or ethambutol (aRD 0.09, 95% CI 0.04–0.13). In patients meeting WHO criteria for its use, the standardised shorter regimen was associated with substantially less loss to follow-up during treatment compared with individualised longer regimens and with more failure or relapse in the presence of resistance to component medications. Our findings support the need to improve access to reliable drug susceptibility testing.

UR - http://www.scopus.com/inward/record.url?scp=85082147486&partnerID=8YFLogxK

U2 - 10.1183/13993003.01467-2019

DO - 10.1183/13993003.01467-2019

M3 - Article

SN - 0903-1936

VL - 55

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 3

M1 - 1901467

ER -

Standardised shorter regimens versus individualised longer regimens for rifampin- or multidrug-resistant tuberculosis

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