In a recent study published in infection journalinvestigators conducted a systematic literature review of the global treatment outcomes for a wide range of drug-resistant tuberculosis.
The study found that only 44.2% of affected individuals had a successful treatment outcome, which is disappointing considering the World Health Organization’s (WHO) goal of achieving 75% treatment success. It’s a low number.
study: Global treatment outcomes for widespread drug-resistant tuberculosis in adults: a systematic review and meta-analysis. Image credit: LiliiaLysenko/Shutterstock.com
From 2020 to 2021, there will be 450,000 new cases of rifampicin-resistant TB globally, and cases of advanced drug-resistant TB are increasing.
Treatment involves daily injections for over 18 months, making it an expensive and cumbersome health condition to treat. In addition, viral strains with weak drug resistance have poor therapeutic outcomes. Mycobacterium tuberculosis.
For the current study, the researchers extensively searched multiple databases, including PubMed, Web of Science, and Embase, from 2005 to April 2023, and found cohorts of at least 10 adults who had widespread drug resistance. We found studies that reported WHO outcomes for tuberculosis patients. Based on 2006 and 2021 WHO definitions.
WHO will update its broad definition of drug-resistant tuberculosis in 2021. Mycobacterium tuberculosis Strains resistant to rifampicin, isoniazid, one fluoroquinolone, and at least one Group A drug (such as moxifloxacin).
Furthermore, the last WHO report documenting treatment outcomes for drug-resistant tuberculosis was published in 2019.
Although new and promising treatment options for drug-resistant tuberculosis are now emerging, concerns remain about access to healthcare and the development of drug resistance. The researchers therefore aimed to use data published by WHO to determine the proportion of highly drug-resistant TB patients who would be successful in treatment by 2023.
The researchers used the Newcastle-Ottawa Scale (NOS) and the Jadad Scale to assess the risk of bias in the included observational studies and randomized controlled trials (RCTs), respectively. The study results are pooled rates of successful and unsuccessful treatment outcomes for pre-drug-resistant and widespread drug-resistant TB.
To address heterogeneity between studies, assess using: ITwo statistics used random-effects meta-analyses and applied logit transformation and inverse variance methods. They also used his Clopper-Pearson CI for individual studies.
The authors identified 5,056 articles, including 72, 22, 3, and 10 studies that broadly reported only outcomes in drug-resistant TB and We report both pre- and broad-spectrum drug-resistant TB outcomes, non-approvable outcomes based on resistance, and drug-resistant TB outcomes only. Outcomes prior to highly drug-resistant tuberculosis only, respectively.
Overall, they found 94 studies from 26 countries, with a total sample size of 10,223 patients suffering from widespread drug-resistant tuberculosis.
Globally, only 44% of patients with widespread drug-resistant TB achieve treatment outcomes, well below the WHO target of 75% treatment success.
For patients with stratified data, this number drops further to 27%, a current situation comparable to the pre-antibiotic era.
Taken together, this means that in this past era of treating widespread drug-resistant tuberculosis using poor regimens, treatment has improved with the sole exception of WHO-approved bedaquiline, pretomanide and linezolid (BPaL) regimens. rather, it suggests that it is stagnating.
It is a 6-month oral regimen for highly drug-resistant tuberculosis, and patients receiving BPaL for 26 weeks typically achieve good outcomes.
Encouragingly, a shorter, more tolerated and effective treatment regimen with BPaL, with or without moxifloxacin, may improve treatment outcomes by up to 90%. Since 2013, treatment outcomes have improved slightly.
However, it should be noted that countries with a high incidence of drug-resistant TB, such as Angola, Bangladesh, and Angola, have fewer resources for TB surveillance and research, and as a result, treatment success may be overestimated. It is important to
The study also identified several known risk factors, such as male sex, older age, and smoking, that lead to poorer outcomes for patients with drug-resistant tuberculosis. Even co-infection with human immunodeficiency virus (HIV) has a devastating synergistic effect in tuberculosis patients.
Even in this new era, with new and broader definitions of drug-resistant TB and promising treatments, continued efforts to combat drug-resistant TB are critical.
More importantly, clinicians, health professionals and policy makers must make prevention and control of this deadly disease a top priority.
Nonetheless, the results of this study provide an immediate reference when evaluating treatment outcomes for a wide range of drug-resistant tuberculosis in patients treated with BPaL and similar future regimens.
Pedersen, OS, Holmgaard, FB, Mikkelsen, MKD, Lange, C., Sotgiu, G., Lillebaek, T., Andersen, AB, Wejse, CM & Dahl, VN (2023) Widespread drug-resistant tuberculosis worldwide. Outcomes in adults: a systematic review and meta-analysis. infection journal. Doi: 10.1016/j.jinf.2023.06.014. https://www.journalofinfection.com/article/S0163-4453(23)00337-7/fulltext