Title
Drug resistance beyond extensively drugresistant tuberculosis: Individual patient data meta-analysis
Date Issued
01 July 2013
Access level
open access
Resource Type
journal article
Author(s)
Migliori G.B.
Sotgiu G.
Gandhi N.R.
Falzon D.
DeRiemer K.
Centis R.
Hollm-Delgado M.G.
Palmero D.
Pérez-Guzmán C.
Vargas M.H.
D'Ambrosio L.
Spanevello A.
Bauer M.
Chan E.D.
Schaaf H.S.
Keshavjee S.
Holtz T.H.
Menzies D.
Ahuja S.
Ashkin D.
Avendano M.
Banerjee R.
Becerra M.C.
Benedetti A.
Burgos M.
Chiang C.Y.
Cox H.
Dung N.H.
Enarson D.
Flanagan K.
Flood J.
Garcia-Garcia L.
Granich R.M.
Iseman M.D.
Jarlsberg L.G.
Kim H.R.
Koh W.J.
Lancaster J.
Lange C.
De Lange W.C.M.
Leimane V.
Leung C.C.
Li J.
Mishustin S.P.
Mitnick C.D.
Narita M.
O'Riordan P.
Pai M.
Park S.K.
Pasvol G.
Pena J.
Ponce-De-Leon A.
Quelapio M.I.D.
Riekstina V.
Robert J.
Royce S.
Seung K.J.
Shah L.
Shim T.S.
Shin S.S.
Shiraishi Y.
Sifuentes-Osornio J.
Strand M.J.
Tabarsi P.
Tupasi T.E.
Van Altena R.
Van Der Walt M.
Van Der Werf T.S.
Viiklepp P.
Westenhouse J.
Yew W.W.
Yim J.J.
Hanover
Publisher(s)
European Respiratory Society
Abstract
The broadest pattern of tuberculosis (TB) drug resistance for which a consensus definition exists is extensively drug-resistant (XDR)-TB. It is not known if additional drug resistance portends worsened patient outcomes. This study compares treatment outcomes of XDR-TB patients with and without additional resistance in order to explore the need for a new definition. Individual patient data on XDR-TB outcomes were included in a meta-analysis comparing outcomes between XDR alone and three nonmutually exclusive XDR-TB patient groups: XDR plus resistance to all the second-line injectables (sli) and capreomycin and kanamycin/amikacin (XDR+2sli) XDR plus resistance to second-line injectables and to more than one group 4 drug, i.e. ethionamide/protionamide, cycloserine/ terizidone or para-aminosalicylic acid (XDR+sliG4) and XDR+sliG4 plus resistance to ethambutol and/or pyrazinamide (XDR+sliG4EZ). Of 405 XDR-TB cases, 301 were XDR alone, 68 XDR+2sli, 48 XDR+sliG4 and 42 XDR+sliG4EZ. In multivariate analysis, the odds of cure were significantly lower in XDR+2sli (adjusted OR 0.4, 95%CI 0.2- 0.8) compared to XDR alone, while odds of failure and death were higher in all XDR patients with additional resistance (adjusted OR 2.6-2.8). Patients with additional resistance beyond XDR-TB showed poorer outcomes. Limitations in availability, accuracy and reproducibility of current drug susceptibility testing methods preclude the adoption of a useful definition beyond the one currently used for XDR-TB. Copyright © ERS 2013.
Start page
169
End page
179
Volume
42
Issue
1
Language
English
OCDE Knowledge area
Sistema respiratorio
Scopus EID
2-s2.0-84880158505
PubMed ID
Source
European Respiratory Journal
ISSN of the container
09031936
Sources of information:
Directorio de Producción Científica
Scopus