Factors associated with treatment outcome of MDR/RR-TB patients treated with shorter injectable based regimen in West Java Indonesia

Abstract

Background and aims Multi drug or rifampicin resistant tuberculosis (MDR/RR-TB) is a major burden to TB prevention and eradication globally. Since 2016, WHO guidelines have included options for treating MDR/RR-TB with a standard regimen of 9 to 11 months duration (the ’shorter regimen’) rather than an individual regimen of at least 20 months. This regimen has been introduced in Indonesia since September 2017. Therefore, we aimed to determine the success rate and factors associated with the treatment outcome of shorter injectable based regimen in West Java province, Indonesia. Methods This was a retrospective cohort study of MDR/RR-TB patients aged over 18 years old who received the shorter injectable based regimen between September 2017 and December 2020. We defined successful outcomes as the combined proportion of patients who were cured or had complete treatment. While, unsuccessful outcomes were defined as the combined proportion of patients who died from any causes, failure, and loss to follow-up (LTFU). Results A total of 315 patients were included in this study. The success rate was 64.5%. Multivariate analysis showed male gender (aRR = 1.18, 95% CI 1.04 to 1.34) increased the chance of successful outcome, while malnutrition (aRR = 0.78, 95% CI 0.68 to 0.89), history of previous TB treatment (aRR = 0.80%CI 0.68 to 0.94), and time of culture conversion >2 months (aRR = 0.72 (95% CI 0.59 to 0.87) decreased the chance of successful outcome. Conclusion History of previous TB treatment, time of culture conversion >2 months, and malnutrition were independent factors that decrease the chance for success rate, while male gender increase the likelihood for success rate of patients treated by the shorter injectable based regimen.

Factors affecting the treatment outcome of injection based shorter MDR-TB regimen at a referral centre in India

“…Therefore, nutrition plays a crucial role in breaking the cycle of malnutrition and tuberculosis. Piubello et al [10] and Soeroto et al [11] had similar findings in their study in MDR patients who received shorter regimen and found low BMI as a predictor for poor outcome. In addition, Singla et al [12] and Aung e. al.…”

“…Our study also found that multiple courses (≥2) in the previous history of ATT significantly associated with unsuccessful outcome. Soeroto et al [11] and Wahid et al [25] in their study found that the history of previous TB treatment decreases the likelihood of successful outcome and associated with treatment failure in MDR TB patients who received shorter regimen.…”

“…Our study suggests that anaemia is an independent risk factor for both mortality and unsuccessful outcome. Soeroto et al [11] observed in MDR-TB patients with anaemia who received shorter regimen had a lower chance of successful outcomes. Singla et al [12] found, factors significantly associated with mortality was anaemia and other studies have also shown that anaemia is associated with poor prognosis and increased risk of mortality in TB patients [16,17].…”

Six Months of Bedaquiline-Pretomanid-Linezolid (BPaL) Regimen in Patients with Drug-Resistant Tuberculosis: A Narrative Review

“…[22] Furthermore, a study by Avaliani et al demonstrated that in MDR-TB patients in Georgia receiving five drugs of STR (bedaquiline, linezolid, levofloxacin, clofazimine, and cycloserine), the treatment success was 22/25 (88%). [23] Treatment success of more than 90% in Bedaquiline, Pretomanid, and Linezolid ( BPaL) regimen was higher compared to the study by Soeroto et al, who reported that 64.5% of successful treatment in Indonesian MDR/RR-TB patients treated with the second line injectablecontaining 7-drug STR [3].…”

“…The administration of second-line injectable drugs (SLID), such as amikacin, kanamycin, and capreomycin for the treatment of DR-TB was associated with poor clinical outcomes, severe adverse effects, and a low cure rate. [3,4] WHO recommended a fully oral regimen containing bedaquiline to treat DR-TB patients. [5] Bedaquiline, a novel antituberculosis drug, offers a high proportion of treatment success and cure rate in MDR-TB patients.…”