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Lachenal N, Hewison C, Mitnick C, Lomtadze N, Coutisson S, Osso E, Ahmed S, Leblanc G, Islam S, Atshemyan H, Nair P, Kholikulov B, Aiylchiev S, Zarli K, Adnan S, Krisnanda A, Padayachee S, Stambekova A, Sahabutdinova Y, de Guadalupe S, Moreno P, Kumsa A, Reshid A, Makaka J, Abebe S, Melikyan N, Seung KJ, Khan U, Khan P, Huerga H, Rich M, Varaine F. Setting up pharmacovigilance based on available endTB Project data for bedaquiline. Int J Tuberc Lung Dis 2020; 24:1087-1094. [DOI: 10.5588/ijtld.20.0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Active pharmacovigilance (PV) is recommended for TB programmes, notably for multidrug-resistant TB (MDR-TB) patients treated with new drugs. Launched with the support of UNITAID in April 2015, endTB (Expand New Drug markets for TB) facilitated treatment with bedaquiline
(BDQ) and/or delamanid of >2600 patients in 17 countries, and contributed to the creation of a central PV unit (PVU).OBJECTIVE: To explain the endTB PVU process by describing the serious adverse events (SAEs) experienced by patients who received BDQ-containing regimens.DESIGN:
The overall PV strategy was in line with the ‘advanced´ WHO active TB drug safety monitoring and management (aDSM) system. All adverse events (AEs) of clinical significance were followed up; the PVU focused on signal detection from SAEs.RESULTS and CONCLUSION: Between
1 April 2015 and 31 March 2019, the PVU received and assessed 626 SAEs experienced by 417 BDQ patients. A board of MDR-TB/PV experts reviewed unexpected and possibly drug-related SAEs to detect safety signals. The experts communicated on clusters of risks factors, notably polypharmacy and
off-label drug use, encouraging a patient-centred approach of care. Organising advanced PV in routine care is possible but demanding. It is reasonable to expect local/national programmes to focus on clinical management, and to limit reporting to aDSM systems to key data, such as the SAEs.
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Affiliation(s)
- N. Lachenal
- Médecins Sans Frontières (MSF), Geneva, Switzerland
| | | | - C. Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, Partners In Health (PIH), Boston, MA, USA
| | - N. Lomtadze
- Ministry of Health, Surveillance and Strategic Planning Department, Tbilisi, Georgia
| | - S. Coutisson
- Médecins Sans Frontières (MSF), Geneva, Switzerland
| | - E. Osso
- Partners In Health (PIH), Boston, MA, USA, Harvard Medical School, Boston, MA, USA
| | - S. Ahmed
- Interactive Research and Development (IRD), Karachi, Pakistan
| | | | | | | | | | | | | | | | - S. Adnan
- Indus Health Network, Karachi, Pakistan
| | | | | | | | | | | | | | | | | | | | | | | | - K. J. Seung
- Partners In Health (PIH), Boston, MA, USA, Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, USA
| | | | | | | | - M. Rich
- Partners In Health (PIH), Boston, MA, USA, Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, USA
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Ulmasova DJ, Uzakova G, Tillyashayhov MN, Turaev L, van Gemert W, Hoffmann H, Zignol M, Kremer K, Gombogaram T, Gadoev J, du Cros P, Muslimova N, Jalolov A, Dadu A, de Colombani P, Telnov O, Slizkiy A, Kholikulov B, Dara M, Falzon D. Multidrug-resistant tuberculosis in Uzbekistan: results of a nationwide survey, 2010 to 2011. ACTA ACUST UNITED AC 2013; 18. [PMID: 24176581 DOI: 10.2807/1560-7917.es2013.18.42.20609] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multidrug-resistant tuberculosis (MDR-TB; resistance to at least rifampicin and isoniazid) is a global public health concern. In 2010–2011, Uzbekistan, in central Asia, conducted its first countrywide survey to determine the prevalence of MDR-TB among TB patients. The proportion of MDR-TB among new and previously treated TB patients throughout the country was measured and risk factors for MDR-TB explored. A total of 1,037 patients were included. MDR-TB was detected in 165 treatment-naïve (23.2%; 95% confidence interval (CI) 17.8%–29.5%) and 207 previously treated (62.0%; 95% CI: 52.5%–70.7%) patients. In 5.3% (95% CI: 3.1%–8.4%) of MDR-TB cases, resistance to fluoroquinolones and second-line injectable drugs (extensively drug resistant TB; XDR-TB) was detected. MDR-TB was significantly associated with age under 45 years (adjusted odds ratio: 2.24; 95% CI: 1.45–3.45), imprisonment (1.93; 95% CI: 1.01–3.70), previous treatment (4.45; 95% CI: 2.66–7.43), and not owning a home (1.79; 95% CI: 1.01–3.16). MDR-TB estimates for Uzbekistan are among the highest reported in former Soviet Union countries. Efforts to diagnose, treat and prevent spread of MDR-TB need scaling up.
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