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    Mar 07, 2021
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    Standardised shorter regimens individualised longer regimens for rifampin- or multidrug-resistant tuberculosis.

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    Abidi et al 2020 Standardised ...
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    Authors
    Abidi, S
    Achar, J
    Neino, MMA
    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
    Maug, AKJ
    Menzies, D
    Migliori, GB
    Miller, A
    Myrzaliev, B
    Ndjeka, N
    Noeske, J
    Parpieva, N
    Piubello, A
    Schwoebel, V
    Welile, S
    Singla, R
    Souleymane, MB
    Trebucq, V
    Van Deun, A
    Viney, K
    Weyer, K
    Zhang, BJ
    Khan, FA
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    Issue Date
    2020-03-20
    Submitted date
    2021-02-22
    
    Metadata
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    Journal
    The European Respiratory Journal
    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 13 104 (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.
    Publisher
    European Respiratory Society
    URI
    http://hdl.handle.net/10144/619876
    DOI
    10.1183/13993003.01467-2019
    PubMed ID
    31862767
    Type
    Article
    Other
    Language
    en
    EISSN
    1399-3003
    ae974a485f413a2113503eed53cd6c53
    10.1183/13993003.01467-2019
    Scopus Count
    Collections
    TB

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