Aggressive Regimens for Multidrug-Resistant Tuberculosis Decrease All-Cause Mortality

作者:Mitnick Carole D*; Franke Molly F; Rich Michael L; Alcantara Viru Felix A; Appleton Sasha C; Atwood Sidney S; Bayona Jaime N; Bonilla Cesar A; Chalco Katiuska; Fraser Hamish S F; Furin Jennifer J; Guerra Dalia; Hurtado Rocio M; Joseph Keith; Llaro Karim; Mestanza Lorena; Mukherjee Joia S; Munoz Maribel; Palacios Eda; Sanchez Epifanio; Seung Kwonjune J; Shin Sonya S; Sloutsky Alexander; Tolman Arielle W; Becerra Mercedes C
来源:PLos One, 2013, 8(3): e58664.
DOI:10.1371/journal.pone.0058664

摘要

Rationale: A better understanding of the composition of optimal treatment regimens for multidrug-resistant tuberculosis (MDR-TB) is essential for expanding universal access to effective treatment and for developing new therapies for MDR-TB. Analysis of observational data may inform the definition of an optimized regimen. %26lt;br%26gt;Objectives: This study assessed the impact of an aggressive regimen-one containing at least five likely effective drugs, including a fluoroquinolone and injectable-on treatment outcomes in a large MDR-TB patient cohort. %26lt;br%26gt;Methods: This was a retrospective cohort study of patients treated in a national outpatient program in Peru between 1999 and 2002. We examined the association between receiving an aggressive regimen and the rate of death. %26lt;br%26gt;Measurements and Main Results: In total, 669 patients were treated with individualized regimens for laboratory-confirmed MDR-TB. Isolates were resistant to a mean of 5.4 (SD 1.7) drugs. Cure or completion was achieved in 66.1% (442) of patients; death occurred in 20.8% (139). Patients who received an aggressive regimen were less likely to die (crude hazard ratio [HR]: 0.62; 95% CI: 0.44,0.89), compared to those who did not receive such a regimen. This association held in analyses adjusted for comorbidities and indicators of severity (adjusted HR: 0.63; 95% CI: 0.43,0.93). %26lt;br%26gt;Conclusions: The aggressive regimen is a robust predictor of MDR-TB treatment outcome. TB policy makers and program directors should consider this standard as they design and implement regimens for patients with drug-resistant disease. Furthermore, the aggressive regimen should be considered the standard background regimen when designing randomized trials of treatment for drug-resistant TB.

  • 出版日期2013-3-13