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Sun W, Wu Z, Zhou Y, Xia F, Tang Q, Wang J, Yang J, Yu F, Yang H, Xiao H, Fan L. A highly effective and inexpensive standardized treatment of multidrug-resistant tuberculosis: a multicenter prospective study in China. BMC Infect Dis 2021; 21:834. [PMID: 34412615 PMCID: PMC8374408 DOI: 10.1186/s12879-021-06553-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To verify the efficacy and safety of an inexpensive standardized regimen for multidrug-resistant tuberculosis (MDR-TB) with low resistance to isoniazid (INH), a multicenter prospective study was conducted in eastern China. METHODS Patients diagnosed as MDR-TB with low concentration INH resistance and rifampicin resistance, second-line/injectable agents sensitive were prospectively enrolled, given the regimen of Amikacin (Ak)-Fluoroquinolones (FQs)-Cycloserine (Cs)-Protionamide (Pto)-PasiniaZid (Pa)-Pyrazinamide (Z) for 6 months followed by 12 months of FQs-Cs-Pto-Pa-Z, and then followed up for treatment outcomes and adverse events (AEs). RESULTS A total of 114 patients were enrolled into the study. The overall favorable treatment rate was 79.8% (91/114). Among 91 cases with favorable treatment, 75.4% (86/114) were cured and 4.4% (5/114) were completed treatment. Regarding to unfavorable outcomes, among 23 cases, 8.8% (10/114) had failures, 8.8% (10/114) losing follow up, 0.9% (1/114) had treatment terminated due to intolerance to drugs and 1.8% (2/114) died. Treatment favorable rate was significantly higher in newly treated MDR-TB (91.7%, 33/36) than that in retreated MDR-TB (74.4%, 58/78, p 0.03). The investigators recorded 42 AEs occurrences in 30 of 114 patients (26.3%). Clinicians rated most AEs as mild or moderate (95.24%, 40/42). CONCLUSIONS The regimen was proved to be effective, safe and inexpensive. It is suitable for specific drug resistant population, especially for newly-treated patients, which could be expected to be developed into a short-course regimen. Clinical trials registration China Clinical Trial Registry ChiCTR-OPC-16009380.
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Affiliation(s)
- Wenwen Sun
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Shanghai Clinical Research Center for Tuberculosis, Tongji University School of Medicine, Shanghai, 200433, China
| | - Zheyuan Wu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ying Zhou
- Shanghai Xuhui District Central Hospital, Shanghai, China
| | - Fan Xia
- Department of Pulmonary Disease, PLA 905 Hospital, Shanghai, China
| | - Qin Tang
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Shanghai Clinical Research Center for Tuberculosis, Tongji University School of Medicine, Shanghai, 200433, China
| | - Jie Wang
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Shanghai Clinical Research Center for Tuberculosis, Tongji University School of Medicine, Shanghai, China
| | - Jinghui Yang
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fangyou Yu
- Department of Clinical Laboratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Yang
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Shanghai Clinical Research Center for Tuberculosis, Tongji University School of Medicine, Shanghai, China
| | - Heping Xiao
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Shanghai Clinical Research Center for Tuberculosis, Tongji University School of Medicine, Shanghai, 200433, China.
| | - Lin Fan
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Shanghai Clinical Research Center for Tuberculosis, Tongji University School of Medicine, Shanghai, 200433, China.
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Li Q, Shi CX, Lu M, Wu L, Wu Y, Wang M, Wang L, Zhao G, Xie L, Qian HZ. Treatment outcomes of multidrug-resistant tuberculosis in Hangzhou, China, 2011 to 2015. Medicine (Baltimore) 2020; 99:e21296. [PMID: 32791713 PMCID: PMC7387009 DOI: 10.1097/md.0000000000021296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging. More research is needed to understand treatment outcomes and associated factors.A retrospective cohort study was conducted to assess trends and predictors of treatment success among 398 MDR-TB and extensively drug resistant TB patients who started treatment in 2011 to 2015 in Hangzhou, China. Sociodemographic and clinical characteristic data were obtained from the national reporting database. Chi-square test for trend was used to evaluate changes in treatment success rates over the study years, and Cox regression analysis was used to identify predictors for poor treatment outcomes.The treatment success rate was 76% (301/398) for all participants, 77% (298/387) for MDR-TB cases and 27% (3/11) for extensively drug-resistant tuberculosis -TB cases. Treatment success increased significantly from 66% among patients who started treatment in 2011 to 85% in 2015 (P < .01). Of the 97 (24.4%) patients with unsuccessful treatment outcomes, 10 (2.5%) died, 64 (16.1%) failed treatment, and 23 (5.8%) were lost to follow-up. Patients who started treatment in 2013 to 2015 were less likely to have unsuccessful outcomes than those who started in 2011-2012 (adjusted odds ratio [AOR] 0.4, 95% confidence interval [CI] 0.3-0.6), patients ≥25 years were more likely to have unsuccessful outcomes than younger patients (AOR 1.6, 95% CI 1.3-2.1), and cases with kanamycin resistance was associated with three times the odds of having unsuccessful outcomes than kanamycin-susceptible cases (AOR 3.0, 95% CI 1.5-5.8).With proper case management of MDR-TB, patients can achieve a high treatment success rate. Hangzhou's program offers clinical evidence that can be used to inform MDR-TB programs elsewhere in China and abroad.
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Affiliation(s)
- Qingchun Li
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Cynthia X. Shi
- Center for Interdisciplinary Research on AIDS and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Min Lu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Limin Wu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Yifei Wu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Meng Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Le Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Gang Zhao
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Li Xie
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Han-Zhu Qian
- SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University, Shanghai, China
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
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Van LH, Phu PT, Vinh DN, Son VT, Hanh NT, Nhat LTH, Lan NH, Vinh TV, Trang NTM, Ha DTM, Thwaites GE, Thuong NTT. Risk factors for poor treatment outcomes of 2266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study. BMC Infect Dis 2020; 20:164. [PMID: 32087682 PMCID: PMC7036193 DOI: 10.1186/s12879-020-4887-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/13/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcomes. Predictors of poor outcomes vary in different regions. Vietnam is among the top 30 high burden of MDR-TB countries. We describe demographic characteristics and identify risk factors for poor outcome among patients with MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam. METHODS This retrospective study included 2266 patients who initiated MDR-TB treatment between 2011 and 2015 in HCMC. Treatment outcomes were available for 2240 patients. Data was collected from standardized paper-based treatment cards and electronic records. A Kruskal Wallis test was used to assess changes in median age and body mass index (BMI) over time, and a Wilcoxon test was used to compare the median BMI of patients with and without diabetes mellitus. Chi squared test was used to compare categorical variables. Multivariate logistic regression with multiple imputation for missing data was used to identify risk factors for poor outcomes. Statistical analysis was performed using R program. RESULTS Among 2266 eligible cases, 60.2% had failed on a category I or II treatment regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. The notification rate increased 24.7% from 2011 to 2015. The treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (adjusted odds ratio (aOR): 2.94), advanced age (aOR: 1.45 for every increase of 5 years for patients 60 years or older), having history of MDR-TB treatment (aOR: 5.53), sputum smear grade scanty or 1+ (aOR: 1.47), smear grade 2+ or 3+ (aOR: 2.06), low BMI (aOR: 0.83 for every increase of 1 kg/m2 of BMI for patients with BMI < 21). CONCLUSION The number of patients diagnosed with MDR-TB in HCMC increased by almost a quarter between 2011 and 2015. Patients with HIV, high smear grade, malnutrition or a history of previous MDR-TB treatment are at greatest risk of poor treatment outcome.
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Affiliation(s)
- Le Hong Van
- Tuberculosis group, Oxford University Clinical Research Unit, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Vietnam.
| | - Phan Trieu Phu
- Tuberculosis group, Oxford University Clinical Research Unit, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Vietnam
| | - Dao Nguyen Vinh
- Tuberculosis group, Oxford University Clinical Research Unit, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Vietnam
| | - Vo Thanh Son
- Tuberculosis group, Oxford University Clinical Research Unit, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Hanh
- Tuberculosis group, Oxford University Clinical Research Unit, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Vietnam
| | - Le Thanh Hoang Nhat
- Tuberculosis group, Oxford University Clinical Research Unit, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Guy E Thwaites
- Tuberculosis group, Oxford University Clinical Research Unit, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nguyen Thuy Thuong Thuong
- Tuberculosis group, Oxford University Clinical Research Unit, 764 Vo Van Kiet street, District 5, Ho Chi Minh City, Vietnam.
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