High success and low recurrence with shorter treatment regimen for multidrug-resistant TB in Nepal.

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2021-11-01 DOI:10.5588/pha.21.0041

S Koirala, N P Shah, P Pyakurel, M Khanal, S K Rajbhandari, T Pun, B Shrestha, B Maharjan, S Karki, S Koirala, K B Tamang, A Roggi, A M V Kumar, N Ortuño-Gutiérrez

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Abstract

Setting: Nine drug-resistant TB centres, some of them supported by Damien Foundation in Nepal where >80% of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) patients are treated.

Objective: To assess the uptake, effectiveness and safety of the 9-12-month shorter treatment regimen (STR) in MDR/RR-TB patients registered from January 2018 to December 2019.

Design: This was a cohort study involving secondary programme data.

Results: Of 631 patients, 301 (48.0%) started and continued STR. Key reasons for ineligibility to start/continue STR were baseline resistance or exposure to second-line drugs (62.0%), contact with extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (7.0%) patients and unavailability of STR drugs (6.0%). Treatment success was 79.6%; unsuccessful outcomes were death (12.0%), lost to follow-up (5.3%), failure (2.7%) and not evaluated (0.7%). Unsuccessful outcomes were significantly associated with HIV positivity and patient age ⩾55 years, with adjusted relative risk of respectively 2.39 (95% CI 1.52-3.77) and 3.86 (95% CI 2.30-6.46). Post-treatment recurrence at 6 and 12 months was respectively 0.5% and 2.4%. Serious adverse events (SAEs) were seen in 15.3% patients - hepatotoxicity and ototoxicity were most common.

Conclusion: STR had a modest uptake, high treatment success and low post-treatment recurrence. For proper detection and management of SAEs, improving pharmacovigilance might be considered. Availability of rapid diagnostic test for second-line drugs is crucial for correct patient management.

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尼泊尔耐多药肺结核患者采用较短疗程治疗的成功率高、复发率低。

环境：九个耐药结核病中心，其中一些得到了尼泊尔达米安基金会的支持，超过80%的耐多药/耐利福平结核病（MDR/RR-TB）患者在这些中心接受治疗：评估2018年1月至2019年12月登记的MDR/RR-TB患者对9-12个月短期治疗方案（STR）的接受情况、有效性和安全性：这是一项涉及二级计划数据的队列研究：在 631 名患者中，301 人（48.0%）开始并继续接受 STR 治疗。不符合开始/继续 STR 的主要原因是基线耐药或接触过二线药物（62.0%）、接触过广泛耐药结核病（XDR-TB）或前 XDR-TB 患者（7.0%）以及无法获得 STR 药物（6.0%）。治疗成功率为 79.6%；失败率为死亡（12.0%）、失去随访（5.3%）、失败（2.7%）和未评估（0.7%）。不成功的结果与 HIV 阳性和患者年龄 ⩾55 岁明显相关，调整后的相对风险分别为 2.39 (95% CI 1.52-3.77) 和 3.86 (95% CI 2.30-6.46)。治疗后6个月和12个月的复发率分别为0.5%和2.4%。15.3%的患者出现了严重不良事件（SAE）--肝毒性和耳毒性最为常见：结论：STR 的使用率不高，治疗成功率高，治疗后复发率低。为了正确检测和处理 SAE，可以考虑改进药物警戒。提供二线药物的快速诊断测试对于正确管理患者至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.