1. Aggressive Regimens Reduce Risk of Recurrence After Successful Treatment of MDR-TB.
- Author
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Khan, Faiz Ahmad, Gelmanova, Irina Y., Franke, Molly F., Atwood, Sidney, Zemlyanaya, Nataliya A., Unakova, Irina A., Andreev, Yevgeniy G., Berezina, Valentina I., Pavlova, Vera E., Shin, Sonya S., Yedilbayev, Askar B., Becerra, Mercedes C., and Keshavjee, Salmaan
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MULTIDRUG-resistant tuberculosis , *FLUOROQUINOLONES , *DRUG therapy , *DRUG efficacy , *HEALTH outcome assessment , *THERAPEUTICS - Abstract
Background. We sought to determine whether treatment with a "long aggressive regimen" was associated with lower rates of relapse among patients successfully treated for pulmonary multidrug-resistant tuberculosis (MDR-TB) in Tomsk, Russia. Methods. We conducted a retrospective cohort study of adult patients that initiated MDR-TB treatment with individualized regimens between September 2000 and November 2004, and were successfully treated. Patients were classified as having received "aggressive regimens" if their intensive phase consisted of at least 5 likely effective drugs (including a second-line injectable and a fluoroquinolone) used for at least 6 months post culture conversion, and their continuation phase included at least 4 likely effective drugs. Patients that were treated with aggressive regimens for a minimum duration of 18 months post culture conversion were classified as having received "long aggressive regimens." We used recurrence as a proxy for relapse because genotyping was not performed. After treatment, patients were classified as having disease recurrence if cultures grew MDR-TB or they re-initiated MDR-TB therapy. Data were analyzed using Cox proportional hazard regression. Results. Of 408 successfully treated patients, 399 (97.5%) with at least 1 follow-up visit were included. Median duration of follow-up was 42.4 months (interquartile range: 20.5-59.5), and there were 27 recurrence episodes. In a multivariable complete case analysis (n = 371 [92.9%]) adjusting for potential confounders, long aggressive regimens were associated with a lower rate of recurrence (adjusted hazard ratio: 0.22, 95% confidence interval, .05-.92). Conclusions. Long aggressive regimens for MDR-TB treatment are associated with lower risk of disease recurrence. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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