Group 5 drugs for multidrug-resistant tuberculosis: individual patient data meta-analysis

The role of so-called "group 5" second-line drugs as a part of antibiotic therapy for multidrug-resistant tuberculosis (MDR-TB) is widely debated. We performed an individual patient data meta-analysis to evaluate the effectiveness of several group 5 drugs including amoxicillin/clavulanic a...

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Vydáno v:The European respiratory journal Ročník 49; číslo 1
Hlavní autoři: Fox, Greg J, Benedetti, Andrea, Cox, Helen, Koh, Won-Jung, Viiklepp, Piret, Ahuja, Shama, Pasvol, Geoffrey, Menzies, Dick
Médium: Journal Article
Jazyk:angličtina
Vydáno: England 01.01.2017
Témata:
Adult
Amoxicillin - therapeutic use
Antitubercular Agents - therapeutic use
Clofazimine - therapeutic use
Cohort Studies
Drug Therapy, Combination
Female
Humans
Isoxazoles - therapeutic use
Linezolid - therapeutic use
Logistic Models
Macrolides - therapeutic use
Male
Microbial Sensitivity Tests
Middle Aged
Multivariate Analysis
Oxazolidinones - therapeutic use
Thioacetazone - therapeutic use
Treatment Outcome
Tuberculosis, Multidrug-Resistant - drug therapy
Young Adult
ISSN:1399-3003
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Shrnutí:The role of so-called "group 5" second-line drugs as a part of antibiotic therapy for multidrug-resistant tuberculosis (MDR-TB) is widely debated. We performed an individual patient data meta-analysis to evaluate the effectiveness of several group 5 drugs including amoxicillin/clavulanic acid, thioacetazone, the macrolide antibiotics, linezolid, clofazimine and terizidone for treatment of patients with MDR-TB.Detailed individual patient data were obtained from 31 published cohort studies of MDR-TB therapy. Pooled treatment outcomes for each group 5 drug were calculated using a random effects meta-analysis. Primary analyses compared treatment success to a combined outcome of failure, relapse or death.Among 9282 included patients, 2191 received at least one group 5 drug. We found no improvement in treatment success among patients taking clofazimine, amoxicillin/clavulanic acid or macrolide antibiotics, despite applying a number of statistical approaches to control confounding. Thioacetazone was associated with increased treatment success (OR 2.6, 95% CI 1.1-6.1) when matched controls were selected from studies in which the group 5 drugs were not used at all, although this result was heavily influenced by a single study.The development of more effective antibiotics to treat drug-resistant TB remains an urgent priority.
Bibliografie:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
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ISSN:1399-3003
DOI:10.1183/13993003.00993-2016