Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Evidence-based recommendations for treating persons having presumed latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) tuberculosis (TB) are lacking because published data consist of small observational studies. Tuberculosis incidence in persons treated for latent MDR -...

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Bibliographic Details
Published in:Clinical infectious diseases Vol. 64; no. 12; p. 1670
Main Authors: Marks, Suzanne M, Mase, Sundari R, Morris, Sapna Bamrah
Format: Journal Article
Language:English
Published: United States 15.06.2017
Subjects:
Antitubercular Agents - administration & dosage
Antitubercular Agents - economics
Antitubercular Agents - therapeutic use
Cost-Benefit Analysis
Disease Progression
Drug Resistance, Multiple, Bacterial - drug effects
Ethambutol - economics
Ethambutol - therapeutic use
Fluoroquinolones - economics
Fluoroquinolones - therapeutic use
Humans
Latent Tuberculosis - drug therapy
Latent Tuberculosis - economics
Pyrazinamide - economics
Pyrazinamide - therapeutic use
Treatment Outcome
Tuberculosis, Multidrug-Resistant - drug therapy
Tuberculosis, Multidrug-Resistant - economics
treatment
cost
contacts
tuberculosis
multidrug-resistant
ISSN:1537-6591, 1537-6591
Online Access:Get more information
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Summary:Evidence-based recommendations for treating persons having presumed latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) tuberculosis (TB) are lacking because published data consist of small observational studies. Tuberculosis incidence in persons treated for latent MDR -TB infection is unknown. We conducted a systematic review of studies published 1 January 1994-31 December 2014 to analyze TB incidence, treatment completion and discontinuation, and cost-effectiveness. We considered contacts with LTBI effectively treated if they were on ≥1 medication to which their MDR-TB strain was likely susceptible. We selected studies that compared treatment vs nontreatment outcomes and performed a meta-analysis to estimate the relative risk of TB incidence and its 95% confidence interval. We abstracted data from 21 articles that met inclusion criteria. Six articles presented outcomes for contacts who were treated compared with those not treated for MDR-LTBI; 10 presented outcomes only for treated contacts, and 5 presented outcomes only for untreated contacts. The estimated MDR-TB incidence reduction was 90% (9%-99%) using data from 5 comparison studies. We also found high treatment discontinuation rates due to adverse effects in persons taking pyrazinamide-containing regimens. Cost-effectiveness was greatest using a fluoroquinolone/ethambutol combination regimen. Few studies met inclusion criteria, therefore results should be cautiously interpreted. We found a reduced risk of TB incidence with treatment for MDR-LTBI, suggesting effectiveness in prevention of progression to MDR-TB, and confirmed cost-effectiveness. However, we found that pyrazinamide-containing MDR-LTBI regimens often resulted in treatment discontinuation due to adverse effects.
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ISSN:1537-6591
1537-6591
DOI:10.1093/cid/cix208