Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 Patients
Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. Three recent systematic review...
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| Vydáno v: | PLoS medicine Ročník 9; číslo 8; s. e1001300 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
Public Library of Science
01.08.2012
Public Library of Science (PLoS) |
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| ISSN: | 1549-1676, 1549-1277, 1549-1676 |
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| Abstract | Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.
Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]).
In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary. |
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| AbstractList | Please see later in the article for the Editors' Summary. Background: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. Methods and Findings: Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]). Conclusions: In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary. Dick Menzies and colleagues report findings from a collaborative, individual patient-level meta-analysis of treatment outcomes among patients with multidrug-resistant tuberculosis. Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.BACKGROUNDTreatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]).METHODS AND FINDINGSThree recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]).In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary.CONCLUSIONSIn this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary. BackgroundTreatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.Methods and findingsThree recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]).ConclusionsIn this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary. Background Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. Methods and Findings Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]). Conclusions In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary. Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]). In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary. |
| Audience | Academic |
| Author | Granich, Reuben M. Shim, Tae Sun Falzon, Dennis Pérez-Guzmán, Carlos Sotgiu, Giovanni Holtz, Timothy H. Lange, Christophe Becerra, Mercedes C. Benedetti, Andrea Royce, Sarah Viiklepp, Pirett Park, Seung-kyu Koh, Won-Jung Tabarsi, Payam Narita, Masa Enarson, Donald Pai, Madhukar Kim, Hye-Ryoun Strand, Matthew J. Palmero, Domingo Shah, Lena Ahuja, Shama D. Quelapio, Maria I. D. Avendano, Monika Yim, Jae-Joon Chan, Eward D. Peña, Jose Riekstina, Vija Cox, Helen Banerjee, Rita Flanagan, Katherine Mitnick, Carole D. Shin, Sonya S. Gandhi, Neel Menzies, Dick Seung, Kwonjune J. de Lange, Wiel C. M. Chiang, Chen-Yuan Jarlsberg, Leah G. Yew, Wing Wai Schaaf, H. Simon Keshavjee, Salmaan Ponce-de-Leon, Alfredo O'Riordan, Philly Hollm-Delgado, Maria G. Dung, Nguyen Huy Robert, Jerome Iseman, Michael D. van Altena, Robert Vargas, Mario H. Shiraishi, Yuji Westenhouse, Janice Bayona, Jamie N. Van der Walt, Martie Sifuentes-Osornio, José Lancaster, Joey Leung, Chi Chiu D'Ambrosio, Lia Migliori, Giovanni B. Bauer, Melissa Li, Jiehui DeRiemer, Kathy Leimane, Vaira |
| AuthorAffiliation | 5 Montreal Chest Institute, McGill University, Montreal, Canada 4 Mayo Clinic, Rochester, Minnesota, United States of America 53 Center for Infectious Diseases-California Department of Public Health, Sacramento, California, United States of America 45 Brigham and Women's Hospital, Boston, Massachusetts, United States of America 2 A.G. Holley Hospital, Lantana, Florida, United States of America 1 Bureau of Tuberculosis, New York, New York, United States of America 16 International Union against Tuberculosis and Lung Disease, Paris, France 49 University of Sassari, Sassari, Italy 48 Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, Mexico 27 South African Medical Research Council, Pretoria, South Africa 47 Fukujuji Hospital, Tokyo, Japan 33 Tomsk Oblast Tuberculosis Dispensary, Tomsk, Russia 32 New York City Health and Mental Hygiene, New York, New York, United States of America 14 UC Davis School of Medicine, Davis, California, United States of America 50 Shaheed Behes |
| AuthorAffiliation_xml | – name: 22 Thailand MOPH & US CDC Collaboration, Bangkok, Thailand – name: 39 Universidad Autonoma Madrid, Madrid, Spain – name: 19 California Department of Public Health, Sacramento, California, United States of America – name: 23 National Jewish Health, Denver, Colorado, United States of America – name: 16 International Union against Tuberculosis and Lung Disease, Paris, France – name: 30 Clinic of Tuberculosis and Lung Diseases, Riga, Latvia – name: 34 University of Washington, Seattle, Washington, United States of America – name: 43 Bactériologie-Hygiène – UPMC, Paris, France – name: 35 City Road Medical Centre, London, United Kingdom – name: 24 University of California, San Francisco, San Francisco, United States of America – name: 5 Montreal Chest Institute, McGill University, Montreal, Canada – name: 17 World Health Organization, Geneva, Switzerland – name: 29 University Medical Center Groningen, Groningen, The Netherlands – name: 20 Instituto Nacional de Salud Pública, Mexico, Mexico – name: 44 Stellenbosch University, Stellenbosch, South Africa – name: 54 Grantham Hospital, Hong Kong – name: 49 University of Sassari, Sassari, Italy – name: 3 University of Toronto, Toronto, Canada – name: 13 Médecins Sans Frontières, Capetown, South Africa – name: 36 Hospital F.J. Muñiz, Buenos Aires, Argentina – name: 2 A.G. Holley Hospital, Lantana, Florida, United States of America – name: 18 MRC Laboratories, Banjul, The Gambia – name: 50 Shaheed Beheshti Medical University, Tehran, Iran – name: 12 Wan Fang Hospital, School of Medicine-Taipei Medical University, Taiwan – name: 7 Harvard Medical School, Boston, Massachusetts, United States of America – name: 38 Imperial College London, London, United Kingdom – name: 51 Instituto Nacional de Enfermedades Respiratorias, Mexico, Mexico – name: 14 UC Davis School of Medicine, Davis, California, United States of America – name: 42 Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, Mexico – name: 48 Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, Mexico – name: 53 Center for Infectious Diseases-California Department of Public Health, Sacramento, California, United States of America – name: 32 New York City Health and Mental Hygiene, New York, New York, United States of America – name: 10 WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy – name: 28 Medical Clinic, Tuberculosis Center Borstel, Borstel, Germany – name: 1 Bureau of Tuberculosis, New York, New York, United States of America – name: 40 Instituto de Salud del Estado de Aguascalientes, Mexico, Mexico – name: 15 National TB Control Program, Hanoi, Vietnam – name: 21 Albert Einstein College of Medicine, Bronx, New York, United States of America – name: 52 National Institute for Health Development, Tallinn, Estonia – name: 41 Tropical Disease Foundation, Makati City, Philippines – name: 26 Samsung Medical Center, Seoul, Korea – name: 37 TB Center, Seoul, Korea – name: 31 Tuberculosis and Chest Services, Hong Kong – name: 46 University of Ulsan College of Medicine, Seoul, Korea – name: 6 The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, United States of America – name: 45 Brigham and Women's Hospital, Boston, Massachusetts, United States of America – name: 4 Mayo Clinic, Rochester, Minnesota, United States of America – name: 47 Fukujuji Hospital, Tokyo, Japan – name: 33 Tomsk Oblast Tuberculosis Dispensary, Tomsk, Russia – name: 55 Seoul National University College of Medicine, Seoul, Korea – name: 8 Partners in Health, Boston, Massachusetts, United States of America – name: 9 University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America – name: 11 Denver Veterans Affair Medical Center, Denver, Colorado, United States of America – name: 27 South African Medical Research Council, Pretoria, South Africa – name: Universidad Peruana Cayetano Heredia, Peru – name: 25 Korea Cancer Center Hospital, Seoul, Korea |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22952439$$D View this record in MEDLINE/PubMed |
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| Copyright | COPYRIGHT 2012 Public Library of Science Ahuja et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bauer M, et al. (2012) Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 Patients. PLoS Med 9(8): e1001300. doi:10.1371/journal.pmed.1001300 2012 Ahuja et al 2012 Ahuja et al |
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| Issue | 8 |
| Keywords | Recurrence Confidence Intervals Tuberculosis, Multidrug-Resistant Antitubercular Agents Humans Treatment Failure Adult Female Male Odds Ratio |
| Language | English |
| License | This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. Creative Commons Attribution License |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 All members of the Collaborative Group for Meta-Analysis of Individual Patient Data in MDR-TB are the authors and are listed in the manuscript byline. JR is a Consultant for bioMérieux. WWY has been indirectly sponsored to participate in International Conferences by GlaxoSmithKline and Pfizer in the last 3 years. CDM is on the Scientific Advisory Board for Otsuka pharmaceuticals development of OPC67683 (Delaminid), a new anti-TB compound. SK received salary support from the Eli Lilly Foundation as part of funding for the activities of Partners In Health by the Foundation's MDR-TB Partnership. This funder was not involved in the study design; collection, analysis and interpretation of data; writing of the paper; and/or decision to submit for publication. The Partners In Health project in Tomsk received funding from Mr. Tom White, the Open Society Institute, the Bill and Melinda Gates Foundation, and the Global Fund to fight AIDS, Tuberculosis and Malaria. None of these funders were involved in the study design; collection, analysis and interpretation of data; writing of the paper; and/or decision to submit for publication. KD is an unpaid, volunteer member of the New Diagnostics Working Group (NDWG), formed of members of the Stop TB Partnership. The Secretariat of the NDWG is hosted by FIND (Foundation for New Innovative Diagnostics). JB was working as consultant for Otsuka Pharmaceutical for the implementation of clinical trial in Peru. JB was co PI of a NIH grant in Peru, Epidemiology of Tuberculosis. MP and GP are members of the Editorial Board of PLOS Medicine. All other authors have declared that no competing interests exist. Performed the experiments. Analyzed the data: SDA DA MA RB MBa JB MCB AB MBu RC EDC CYC HC LD KD NHD DE DF KF JF MLGG NRG RG MGHD THH MDI LGJ SK HRK WJK JLL CL WCMD VL CCL JL DM GBM SM CDM MN PO MP DP SKP GP JMP CPG MIDQ AP VR JR SR HSS KJS LS TSS SSS YS JSO GS MS PT TEP RVA MLV TSV MHV PV JW WWY JJY. Contributed reagents/materials/analysis tools: SDA DA MA RB MBa JB MCB AB MBu RC EDC CYC HC LD KD NHD DE DF KF JF MLGG NRG RG MGHD THH MDI LGJ SK HRK WJK JLL CL WCMD VL CCL JL DM GBM SM CDM MN PO MP DP SKP GP JMP CPG MIDQ AP VR JR SR HSS KJS LS TSS SSS YS JSO GS MS PT TEP RVA MLV TSV MHV PV JW WWY JJY. Wrote the first draft of the manuscript: DM. Contributed to the writing of the manuscript: SDA DA MA RB MBa JB MCB AB MBu RC EDC CYC HC LD KD NHD DE DF KF JF MLGG NRG RG MGHD THH MDI LGJ SK HRK WJK JLL CL WCMD VL CCL JL DM GBM SM CDM MN PO MP DP SKP GP JMP CPG MIDQ AP VR JR SR HSS KJS LS TSS SSS YS JSO GS MS PT TEP RVA MLV TSV MHV PV JW WWY JJY. ICMJE criteria for authorship read and met: SDA DA MA RB MBa JB MCB AB MBu RC EDC CYC HC LD KD NHD DE DF KF JF MLGG NRG RG MGHD THH MDI LGJ SK HRK WJK JLL CL WCMD VL CCL JL DM GBM SM CDM MN PO MP DP SKP GP JMP CPG MIDQ AP VR JR SR HSS KJS LS TSS SSS YS JSO GS MS PT TEP RVA MLV TSV MHV PV JW WWY JJY. Agree with manuscript results and conclusions: SDA DA MA RB MBa JB MCB AB MBu RC EDC CYC HC LD KD NHD DE DF KF JF MLGG NRG RG MGHD THH MDI LGJ SK HRK WJK JLL CL WCMD VL CCL JL DM GBM SM CDM MN PO MP DP SKP GP JMP CPG MIDQ AP VR JR SR HSS KJS LS TSS SSS YS JSO GS MS PT TEP RVA MLV TSV MHV PV JW WWY JJY. |
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| Snippet | Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data... Background: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual... Please see later in the article for the Editors' Summary. Background Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual... Dick Menzies and colleagues report findings from a collaborative, individual patient-level meta-analysis of treatment outcomes among patients with... BackgroundTreatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual... Background Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual... |
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| SubjectTerms | Adult Antitubercular Agents - therapeutic use Clinical trials Confidence Intervals Drug resistance Drug therapy Female Health aspects Humans Male Medicine Meta-analysis Odds Ratio Patient outcomes Physiological aspects Pulmonary tuberculosis Recurrence Studies Treatment Failure Tuberculosis Tuberculosis, Multidrug-Resistant - drug therapy |
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| Title | Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 Patients |
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