Title
Group 5 drugs for multidrug-resistant tuberculosis: Individual patient data meta-analysis
Date Issued
01 January 2017
Access level
open access
Resource Type
journal article
Author(s)
Fox G.J.
Benedetti A.
Cox H.
Koh W.J.
Viiklepp P.
Ahuja S.
Pasvol G.
Menzies D.
Ahuja S.
Ashkin D.
Avendaño M.
Banerjee R.
Bauer M.
Hollm-Delgado M.G.
Pai M.
Shah L.
Becerra M.
Burgos M.
Centis R.
D'Ambrosio L.
Migliori G.B.
Chan E.D.
Chiang C.Y.
De Lange W.C.M.
Van Altena R.
Van Der Werf T.S.
De Riemer K.
Dung N.H.
Enarson D.
Falzon D.
Granich R.M.
Flanagan K.
Flood J.
Gandhi N.
Garcia-Garcia L.
Holtz T.H.
Iseman M.
Strand M.J.
Jarlsberg L.G.
Royce S.
Keshavjee S.
Kim H.R.
Mitnick C.D.
Lancaster J.
Van Der Walt M.
Lange C.
Leimane V.
Riekstina V.
Leung C.C.
Li J.
Narita M.
O'Riordan P.
Palmero D.
Park S.K.
Pena J.
Pérez-Guzmán C.
Ponce-De-Leon A.
Sifuentes-Osornio J.
Quelapio M.I.D.
Tupasi T.E.
Robert J.
Schaaf H.S.
Seung K.J.
Shin S.S.
Shim T.S.
Shiraishi Y.
Sotgiu G.
Tabarsi P.
Vargas M.H.
Westenhouse J.
Yew W.W.
Yim J.J.
McGill University
Publisher(s)
European Respiratory Society
Abstract
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.
Volume
49
Issue
1
Language
English
OCDE Knowledge area
Sistema respiratorio Enfermedades infecciosas Salud pública, Salud ambiental
Scopus EID
2-s2.0-85008474067
PubMed ID
Source
European Respiratory Journal
ISSN of the container
09031936
Sources of information: Directorio de Producción Científica Scopus