TY - JOUR
T1 - Clinical management of multidrug-resistant tuberculosis in 16 european countries
AU - TBNET
AU - Günther, G.
AU - Van Leth, F.
AU - Alexandru, S.
AU - Altet, N.
AU - Avsar, K.
AU - Bang, D.
AU - Barbuta, R.
AU - Bothamley, G.
AU - Ciobanu, A.
AU - Crudu, V.
AU - Danilovits, M.
AU - Dedicoat, M.
AU - Duarte, R.
AU - Gualano, G.
AU - Kunst, H.
AU - De Lange, W.
AU - Leimane, V.
AU - McLaughlin, A.-M.
AU - Magis-Escurra, C.
AU - Muylle, I.
AU - Polcová, V.
AU - Popa, C.
AU - Rumetshofer, R.
AU - Skrahina, A.
AU - Solodovnikova, V.
AU - Spinu, V.
AU - Tiberi, S.
AU - Viiklepp, P.
AU - Lange, C.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Copyright © 2018 by the American Thoracic SocietyRationale: Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. Objectives: To document the management and treatment outcome in patients with MDR-TB in Europe. Methods: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). Measurements and Main Results: A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). Conclusions: Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.
AB - Copyright © 2018 by the American Thoracic SocietyRationale: Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. Objectives: To document the management and treatment outcome in patients with MDR-TB in Europe. Methods: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). Measurements and Main Results: A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). Conclusions: Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85044946587&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29509468
U2 - https://doi.org/10.1164/rccm.201710-2141OC
DO - https://doi.org/10.1164/rccm.201710-2141OC
M3 - Article
C2 - 29509468
SN - 1073-449X
VL - 198
SP - 379
EP - 386
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 3
ER -