15-year trends in efficacy and effectiveness of treatment outcomes in drug-resistant pulmonary TB.

Background: This study describes the evolution of treatment outcomes in drug-resistant (DR) pulmonary TB, focusing on efficacy and effectiveness.

Methods: We searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science reporting DR-TB regimens from 1 January 2009 to 8 May 2024 and performed a systematic literature review and meta-analysis.

Results: A gradual increase in success rates in the treatment of DR pulmonary TB was observed from 2009 to 2024 across all studies. In observational studies, the average treatment success rate for mono-resistant TB (non-rifampicin-resistant TB, RR-TB) was 82.9%, while the average treatment success rate for RR/multidrug-resistant TB (MDR-TB) was 68.4%, and that of pre-extensively drug-resistant TB (pre-XDR-TB) and XDR-TB was 54.4% with an increasing trend over time. The outcomes of experimental studies, which included fewer patients, demonstrated 69.6% treatment success for RR/MDR-TB, with higher rates for pre-XDR/XDR-TB (79.2%) and a mix of the two groups (85.8%). Significant geographic variations in outcome rates were observed across studies.

Conclusion: The current study demonstrates a steady improvement in treatment outcomes for DR-TB after a long period of stagnation. However, new drugs and novel regimens are needed to maintain or further improve treatment outcomes in DR-TB.