Institute of Tropical Medicine Antwerp
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Standardised shorter regimens versus individualised longer regimens for multidrug-resistant TB

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Show simple item record Abidi, S. en_US Achar, J. en_US Neino, M. M. A. en_US Bang, D. en_US Benedetti, A. en_US Brode, S. en_US Campbell, J. R. en_US Casas, E. en_US Conradie, F. en_US Dravniece, G. en_US du Cros, P. en_US Falzon, D. en_US Jaramillo, E. en_US Kuaban, C. en_US Lan, Z. en_US Lange, C. en_US Li, P. Z. en_US Makhmudova, M. en_US Maug, A. K. J. en_US Menzies, D. en_US Migliori, G. B. en_US Miller, A. en_US Myrzaliev, B. en_US Ndjeka, N. en_US Noeske, J. en_US Parpieva, N. en_US Piubello, A. en_US Schwoebel, V. en_US Sikhondze, W. en_US Singla, R. en_US Souleymane, M. B. en_US Trebucq, A. en_US Van Deun, A. en_US Viney, K. en_US Weyer, K. en_US Zhang, B. J. en_US Khan, F. A. en_US 2020-08-25T09:37:40Z 2020-08-25T09:37:40Z 2020 en_US
dc.identifier.issn 0903-1936 en_US
dc.identifier.doi en_US
dc.identifier.other ITG-B30A; DBM; U-MYCOB; JIF; DOI; CPDF; Abstract; ITMPUB; DSPACE68 en_US
dc.identifier.other NOBIT en_US
dc.description.abstract We sought to compare the effectiveness of two WHO-recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis: 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 tuberculosis. We used propensity score matched, mixed-effects meta-regression to calculate adjusted odds ratios and adjusted risk differences (aRD) for failure or relapse, death within 12 months of treatment initiation, and loss to follow-up.We included 2625/3378 (77.7%) individuals from 9 studies of shorter regimens, and 2717/13104 (20.7%) 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 to -0.12). The risk difference for failure or relapse was slightly higher with the shorter regimen overall (0.02, 95%CI: 0 to 0.05), and greater in magnitude with baseline resistance to pyrazinamide (0.12, 95%CI: 0.07 to 0.16), prothionamide/ethionamide (0.07, 95%CI: -0.01 to 0.16), or ethambutol (0.09, 95%CI: 0.04 to 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 as compared to individualised longer regimens, and with more failure/relapse in the presence of resistance to component medications. Our findings support the need to improve access to reliable drug susceptibility testing en_US
dc.language English en_US
dc.relation.uri en_US
dc.subject Tuberculosis-multidrug-resistant en_US
dc.subject Bacterial diseases en_US
dc.subject Treatment en_US
dc.subject Drug therapy en_US
dc.title Standardised shorter regimens versus individualised longer regimens for multidrug-resistant TB en_US
dc.type Article en_US
dc.citation.issue 3 en_US
dc.citation.jtitle European Respiratory Journal en_US
dc.citation.volume 55 en_US
dc.citation.pages 1901467 en_US
dc.citation.abbreviation Eur Respir J en_US

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