Treatment Outcomes and Adverse Events from a Standardized Multidrug-Resistant Tuberculosis Regimen in a Rural Setting in Angola

Abstract

Treatment for multidrug-resistant tuberculosis (MDR TB) is associated with adverse events (AE). Patients treated with an MDR TB regimen in Hospital Nossa Senhora da Paz, Cubal, Angola, were prospectively enrolled from May 2013 to July 2015. Baseline characteristics, AE, and clinical and microbiological outcomes were recorded. A total of 216 patients were treated with an MDR TB regimen and 179 (82.9%) patients developed at least one AE. The most common AE were elevation of liver enzymes (46.8% of patients), elevated creatinine (44.4% of patients), and ototoxicity (40.7% of patients). Previous TB treatment was associated with the occurrence of AE (OR 4.89, 95% CI: 2.09–11.46, P < 0.001) and months on treatment was associated to severe AE (OR 1.11 95% CI: 1.04–1.18, P = 0.001). Successful treatment was achieved in 117 (54.2%) patients. Incidence of AE was associated with an unsuccessful outcome (OR 1.23, 95% CI: 1.09–1.40, P = 0.001). Patients treated with MDR TB treatment frequently experience AE, and these are related with previous TB treatment and duration of treatment. Given the high percentage of patients experiencing AE and the low treatment success rates, more effective and less toxic drugs to treat MDR TB are urgently needed.

Treatment outcomes for multidrug- and rifampicin-resistant tuberculosis in Central and West Africa: a systematic review and meta-analysis

“…Study periods ranged from 2005 to 2020 (Ngabonziza et al, 2020, Sifna et al). Eleven studies were retrospective cohort studies (Akinsola et al, 2018, Bakare et al, 2021, Bulabula et al, 2019, Ciza et al, 2020, Ige and Oladokun, 2018, Kamara et al, 2022, Ngabonziza et al, 2020, Sifna et al, Souleymane et al, 2021 and three were prospective (Aznar et al, 2019, Kuaban et al, 2015, Schwoebel et al, 2020. The mean study population size was 304.9 (range 115-845), most patients were males (range 51.3-84.1%) (Kuaban et al, 2015, Souleymane et al, 2021 while the median age ranged from 28 to 35 years (Bulabula et al, 2019, Kamara et al, 2022.…”

“…Two additional articles were obtained from other sources (Kamara et al, 2022, Sifna et al). Of the remaining articles, 14 were included for quantitative analysis (Akinsola et al, 2018, Aznar et al, 2019, Bakare et al, 2021, Bulabula et al, 2019, Ciza et al, 2020, Ige and Oladokun, 2018, Kamara et al, 2022, Kuaban et al, 2015, Ngabonziza et al, 2020, Schwoebel et al, 2020, Sifna et al, Souleymane et al, 2021. Several articles contained overlapping data and were excluded.…”

“…All studies reported the number of HIV co-infected, ranging from 4.1% to 39.9% (Ngabonziza et al, 2020, Souleymane et al, 2021. Seven studies reported using DOT (Aznar et al, 2019, Bakare et al, 2021, Bulabula et al, 2019, Ige and Oladokun, 2018, Kuaban et al, 2015, Schwoebel et al, 2020. Five studies used adaptations of treatment outcomes (Aznar et al, 2019, Ciza et al, 2020, Ige and Oladokun, 2018, Schwoebel et al, 2020.…”

“…Seven studies reported using DOT (Aznar et al, 2019, Bakare et al, 2021, Bulabula et al, 2019, Ige and Oladokun, 2018, Kuaban et al, 2015, Schwoebel et al, 2020. Five studies used adaptations of treatment outcomes (Aznar et al, 2019, Ciza et al, 2020, Ige and Oladokun, 2018, Schwoebel et al, 2020. A single study was included although 11.3% (n=47/413) of patients had XDR-TB (Akinsola et al, 2018).…”

N-Acetyl Cysteine as an Adjunct in the Treatment of Tuberculosis

“…A significant proportion of TB patients undergoing treatment with aminoglycosides develop ototoxicity [6,42,43]. Studies suggested that ototoxicity is more frequent in resource-limited settings than in developed nations [39].…”