Takeaway
- In patients with rifampin- or multidrug-resistant (RR/MDR-TB) who met World Health Organization (WHO) eligibility criteria for the shorter regimen, the standardised shorter regimen (9-12 months) was associated with less loss to follow-up compared with individualised longer regimens (≥20 months), and with more failure/relapse in the presence of resistance to component medications.
Why this matters
- Findings add to the growing body of evidence in support of increasing access to reliable and reproducible drug susceptibility test for all patients with RR/MDR-TB.
Study design
- Study included 2625 participants from 9 studies of shorter regimens and 2717 from 39 studies of longer regimens.
- Main outcomes: failure or relapse, death during treatment and loss to follow-up.
- Funding: WHO Global TB Programme.
Key results
- In aggregate data meta-analysis:
- Treatment success rates (80.0% [95% CI, 72.1-86.1%] vs 75.3% [95% CI, 69.8-80.0%]), the risk for failure or relapse (3.6% [95% CI, 1.3-9.6%] vs 2.7% [95% CI, 1.5-4.7%]) and death (7.6% [95% CI, 4.2-13.1%] vs 4.6% [95% CI, 2.9-7.2%]) were higher with shorter regimen compared with longer regimen.
- Fewer patients in shorter regimen group were lost to follow-up (4.2% [95% CI, 2.3-7.5%] vs 14.6% [95% CI, 11.0-19.0%]).
- In individual patient data meta-analyses:
- Risks for loss to follow-up were lower in shorter vs longer regimen group (adjusted risk difference [aRD], −0.15; 95% CI, −0.17 to −0.12).
- The risk for failure or relapse was higher in patients in shorter regimen group (aRD, 0.02; 95% CI, 0-0.05), especially in those with resistance to pyrazinamide (aRD, 0.12; 95% CI, 0.07-0.16), prothionamide/ethionamide (aRD, 0.07; 95% CI, −0.01 to 0.16) and ethambutol (aRD, 0.09; 95% CI, 0.04-0.13).
Limitations
- Risk of bias because of residual confounding.
References
References
