Moxifloxacin Prophylaxis against MDR TB, New York, New York, USA

Trieu, Lisa; Proops, Douglas; Ahuja, Shama D.

doi:10.3201/eid2103.141313

Cited by 22 publications

(10 citation statements)

References 8 publications

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“…A registry match study [39] reporting results of MOX or PZA/MOX MDR-LTBI treatment regimens used in 2 outbreaks, mostly among persons with HIV, in New York City was published 3 months after completion of our systematic review, but would have been excluded from our meta-analysis because it was a registry match. Of those started on MDR-LTBI treatment, 60% (30/50) completed treatment and 6% (3/50) stopped due to adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, it would take 2–5.5 years to detect 1 incident MDR-TB case (Supplementary Appendix). Attamna et al [7], Feja et al [8], and Trieu et al [39] used registry matches and found no related incident MDR-TB cases. Because MDR-TB is so rare in low-incidence settings and occurs largely in foreign-born persons, it is possible that moves/relocations resulted in no matches.…”

Section: Discussionmentioning

confidence: 99%

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Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Marks

Mase

Morris

2017

Clinical Infectious Diseases

103

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Background Evidence-based recommendations for treating persons having presumed latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) tuberculosis (TB) are lacking because published data consist of small observational studies. Tuberculosis incidence in persons treated for latent MDR -TB infection is unknown. Methods We conducted a systematic review of studies published 1 January 1994–31 December 2014 to analyze TB incidence, treatment completion and discontinuation, and cost-effectiveness. We considered contacts with LTBI effectively treated if they were on ≥1 medication to which their MDR-TB strain was likely susceptible. We selected studies that compared treatment vs nontreatment outcomes and performed a meta-analysis to estimate the relative risk of TB incidence and its 95% confidence interval. Results We abstracted data from 21 articles that met inclusion criteria. Six articles presented outcomes for contacts who were treated compared with those not treated for MDR-LTBI; 10 presented outcomes only for treated contacts, and 5 presented outcomes only for untreated contacts. The estimated MDR-TB incidence reduction was 90% (9%–99%) using data from 5 comparison studies. We also found high treatment discontinuation rates due to adverse effects in persons taking pyrazinamide-containing regimens. Cost-effectiveness was greatest using a fluoroquinolone/ethambutol combination regimen. Conclusions Few studies met inclusion criteria, therefore results should be cautiously interpreted. We found a reduced risk of TB incidence with treatment for MDR-LTBI, suggesting effectiveness in prevention of progression to MDR-TB, and confirmed cost-effectiveness. However, we found that pyrazinamide-containing MDR-LTBI regimens often resulted in treatment discontinuation due to adverse effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Marks

Mase

Morris

2017

Clinical Infectious Diseases

103

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“…In this study [16] of the 50 contacts, initiating moxifloxacinbased prophylaxis in the 2 outbreaks, 30 (60%) completed treatment. Therapy was generally well-tolerated.…”

Section: Importance Of the Studymentioning

confidence: 70%

“…• The likelihood that the contact is newly infected with prophylaxis for the HIV patients with contact history of MDR-TB or suspected MDR-TB patient. The basis of this trial is based on recent study of contacts treated with moxifloxacin-or levofloxacin-based prophylaxis given to the MDR-TB contacts in 2 MDR-TB out breaks [16]. The study found no serious adverse events and fewer cases of disease among those treated than those untreated.…”

Section: Importance Of the Studymentioning

confidence: 99%

Prospective Study of Moxifloxacin prophylaxis in Patients Suffering with HIV Having Contact History of Multidrug Resistant Tuberculosis (MDR-TB)

Pv¹,

Gorantla²,

Rachakonda³

2016

J Pulm Respir Med

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Aim and Objectives: To find out the effectiveness of moxifloxacin prophylaxis in HIV patients having contact history of MDR-TB. Materials and Methods: This is an observational prospective cohort study of HIV patients divided in to two groups, moxifloxacin prophylaxis group and non-prophylaxis group. These groups are followed for four years from March 2012 to March 2016 to appraise the incidence of tuberculosis and mortality in these two cohorts. Results: The tuberculosis incidence in more in non-prophylaxis group when compared to prophylaxis group. Crude tuberculosis incidence is 275 per 1000 person/years in non-prophylaxis group when compared to 42 per 1000 person/ years in prophylaxis group (p<0.005). Incidence of MDR-TB is more in non-prophylaxis group (26 vs 6; p=0.002) when compared to prophylaxis group. Crude mortality rate is more in non-prophylaxis group (774 vs 103; p=0.003) when compared to the other group which was further confirmed by Cox regression hazards model. Proportional hazards model in which moxifloxacin prophylaxis had a 60% decrease in mortality compared to non-prophylaxis (adjusted relative hazard). Conclusion: Prophylaxis with 6-months moxifloxacin is an effective alternative for HIV patients instead of isoniazid suspected to contact with multidrug resistant tuberculosis.

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“…For household contacts of patients with MDR-TB or XDR-TB (MDR-TB with added resistance to fluoroquinolones and second-line injectable agents) there are only observational studies to guide recommendations [44][45][46][47]. The drugs used for MDR-TB contacts have been mainly fluoroquinolones with or without other drugs such as ethambutol or ethionamide.…”

Section: Tb Preventive Therapy Regimensmentioning

confidence: 99%

The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground

et al. 2020

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Ending the tuberculosis (TB) epidemic by 2030 requires two key actions: rapid diagnosis and effective treatment of active TB and identification and treatment of latent TB infection to prevent progression to active disease. We introduce this perspective by documenting the growing importance of TB preventive therapy on the international agenda coupled with global data showing poor implementation of preventive activities in programmatic settings. We follow this with two principal objectives. The first is to examine implementation challenges around diagnosis and treatment of active TB. Within this, we include recent evidence about the continued morbidity and heightened mortality that persists after TB treatment is successfully completed, thus elevating the importance of TB preventive therapy. The second objective is to outline how current TB preventive therapy activities have been shaped and are managed and propose how these can be improved through research and innovation. This includes expanding and giving higher priority to certain high-risk groups including those with fibrotic lung lesions on chest X-ray, showcasing the need to develop and deploy new biomarkers to more accurately predict risk of disease and making shorter treatment regimens, especially with rifapentine-isoniazid, more user-friendly and widely available. Ending the TB epidemic requires not only cure of the disease but preventing it before it even begins.

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Moxifloxacin Prophylaxis against MDR TB, New York, New York, USA

Cited by 22 publications

References 8 publications

Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Prospective Study of Moxifloxacin prophylaxis in Patients Suffering with HIV Having Contact History of Multidrug Resistant Tuberculosis (MDR-TB)

The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground

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