Update of drug-resistant tuberculosis treatment guidelines: A turning point

Vanino, E.; Granozzi, B.; Akkerman, Onno W.; Munoz-Torrico, M.; Palmieri, Fabrizio; Seaworth, Barbara; Tiberi, Simon; Tadolini, Marina

doi:10.1016/j.ijid.2023.03.013

Cited by 32 publications

(31 citation statements)

References 14 publications

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“…Всесвітня організація охорони здоров'я в рекомендаціях 2020 р. щодо лікування лікарсько-стійкого ТБ радить застосовувати в пацієнтів із МЛС-TБ повністю пероральні режими антимікобактеріальної терапії (АМБТ), у тому числі залежно від профілю лікарської стійкості, поширеності ТБ або тяжкості захворювання може використовуватися триваліший (18-20 місяців) пероральний індивідуалізований режим лікування (ІРЛ) [1,7]. При цьому в оновленні цих рекомендацій за 2022 р. чітко вказується, що триваліше (18 місяців) лікування залишається прийнятним варіантом у всіх випадках, коли коротші схеми не можуть бути реалізовані через непереносимість, лікарську взаємодію, ТБ із широкою лікарською стійкістю, великі форми позалегеневого ТБ або попередню невдачу лікування [11].…”

Section: Effectiveness Of Usingunclassified

Effectiveness of using a long-term individualized treatment regimen of tuberculosis with multiple drug resistance in elderly people with concomitant diseases

Raznatovska,

Yasinskyi,

Shalmin

et al. 2023

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BACKGROUND. The actuality of the correct approach to the treatment of elderly patients with multidrug-resistance tuberculosis (MDR-TB) and concomitant diseases is unquestionable. We did not find in the available literature a study of the use of a completely oral long-term individualized treatment regimen (ITR) in this category of patients, which confirms the scientific novelty of the research. OBJECTIVE. To analyze the using of fully oral long-term ITR of MDR-TB in a 73-year-old patient with concomitant diseases on the example our own observation. MATERIALS AND METHODS. A clinical case of our own observation of a patient who was treated in the pulmonary TB department No. 2 of the Zaporizhzhia Regional Phthisiopulmonological Clinical Treatment and Diagnostic Center. RESULTS AND DISCUSSION. A 73-year-old man previously suffered from TB. He fell ill for the first time in 1987 and the first relapse of the specific process occurred in 2010. In both cases the patient received treatment of sensitive to antimycobacterial drugs TB, which ended with a positive outcome. During the relapse case described in the presented work, MDR-TB was diagnosed in the patient. Concomitant diseases of the cardiovascular system and the organ of vision were diagnosed in the patient. Before the ITR course completion the patient suffered a repeated myocardial infarction against the background of alcohol abuse. The patient received a completely oral long-term (18 month) course of MDR-TB ITR: 4 months of Lfx-Bdq-Cfz-Cs-Mpn-Amx/Clv, 2 months of Lfx-Bdq-Cfz-Cs, 12 months of Lfx-Cfz-Cs. Treatment was prescribed considering the data of the drug sensitivity test and the presence of contraindications to the appointment of Lzd. Complete cessation of bacterial excretion was registered after 4 months of antimycobacterial treatment. Tolerability of antimycobacterial therapy was satisfactory, adverse drugs’ reactions were not determined. CONCLUSIONS. The presented clinical case of our own observation demonstrates the high safety and effectiveness of a completely oral long-term (18 months) course of MDR-TB ITR in an elderly person with concomitant diseases, which is new data, since we did not find similar works in the available literature. The obtained data are an addition to the indications for use the all-oral long-term (18 months) course of ITR, including 4 months of Lfx-Bdq-Cfz-Cs-Mpn-Amx/Clv, 2 months of Lfx-Bdq-Cfz-Cs, 12 months of Lfx-Cfz-Cs in elderly patients with the simultaneous course of MDR-TB and concomitant cardiovascular and visual diseases.

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Section: Effectiveness Of Usingunclassified

Effectiveness of using a long-term individualized treatment regimen of tuberculosis with multiple drug resistance in elderly people with concomitant diseases

Raznatovska,

Yasinskyi,

Shalmin

et al. 2023

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“…Considering the overall high treatment success rate in Hangzhou, lack of effective vaccines for MDR-TB [13], and limited availability of new treatment regimens and drugs for MDR-TB [14,15], understanding the prevalence and pattern of MDR among the migrant population can help in the timely detection and treatment of endemic MDR-TB patients, thereby controlling the spread of MDR and addressing the shortcomings in MDR-TB treatment and management in Hangzhou, particularly in the context of the high prevalence of primary drug resistance due to transmission that remains high in Hangzhou [9]. However, little is known about the situation of MDR among the migrant population in Hangzhou.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and epidemic pattern of ecdemic multidrug-resistant tuberculosis during 2012- 2022 in Hangzhou, China

Li,

Wu,

Cheng

et al. 2024

Preprint

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Background To assess the prevalence and epidemic pattern of multidrug-resistant (MDR) tuberculosis in Hangzhou City, Zhejiang Province, China during 2012–2022. Methods All the TB cases undergoing drug susceptibility testing (DST) during 2012–2022 were included in this study. De-identified information was extracted from the electronic database Tuberculosis Information Management System (TBIMS) for analysis of drug resistance prevalence in Hangzhou and ecdemic Multidrug-resistant TB (MDR-TB) which originated from other regions. Chi-square tests were used to compare drug resistance rates between different groups, while Chi-square tests for trend were used to evaluate the change of drug resistance rates over the years of 2012–2022. The sources and destinations of ecdemic MDR-TB were illustrated using a Sankey diagram. Results Of 21,127 cases included in this study, 1119 (5.3%) were MDR. A significant decline in MDR-TB rates was observed during 2012–2022. There was a significant difference in MDR-TB rates among immigrant population and local residents in Hangzhou City. Of 1119 MDR-TB cases, 515(46%) were ecdemic MDR-TB cases, of which 277(53.8%) were from other parts of Zhejiang Province and 238(46.2%) were from other provinces in China. Anhui, Jiangxi and Sichuan were among top three provinces which were the source of ecdemic MDR-TB cases. Three districts including Xiaoshan, Shangcheng and Linping districts had the most cases in Hangzhou. The proportion of ecdemic MDR-TB cases in Binjiang, Xiaoshan, Qiantang and Linping districtalso exceeded 30% of total cases. Conclusions MDR-TB prevalence has been declining in Hangzhou. Migrant population contributed to a significant portion of cases in Hangzhou. Interventions should be tailed to local and migrant residents.

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“…Decision analysis provides a framework to analyze these tradeoffs, and a recent cost-effectiveness study using evidence from TB-PRACTECAL found that 6-months BPaLM may reduce cost and improve health relative to the standard of care in several countries [28]. Our analysis builds on this work by focusing on longer term outcomes that are difficult to measure in a trial setting and by examining a wider range of testing and treatment approaches, including whether patients who must stop moxifloxacin—due to side effects or acquired resistance—should continue on BPaL alone, or BPaL plus clofazimine (BPaLC) [25,28].…”

Section: Introductionmentioning

confidence: 99%

“…In addition to higher prices and supply constraints for newer drugs [20] , [21], it is expected that the rollout of the BPaLM regimen as part of the newer 2022 Guidelines may be delayed by concerns about comparative effectiveness and cost-effectiveness [20][21][22][23][24]. Implementation may also be met with concern over the emergence of drug resistance, particularly in settings with limited capacity to detect resistance to newer agents such as bedaquiline, pretomanid, and linezolid [25]; such capacity constraints are multifactorial, from the expense of investing in new technologies and associated laboratory workforce development, to supply chain interruptions and divergent political priorities [26,27]. The decision to implement the new 6month BPaLM regimen will depend on setting-specific tradeoffs between regimen effectiveness, cost, the complexity of treatment decisions, and existing levels of resistance to anti-TB drugs in the population.…”

Section: Introductionmentioning

confidence: 99%

Impact and cost-effectiveness of the 6-month BPaLM regimen for rifampicin-resistant tuberculosis: a mathematical modeling analysis

James

Klaassen

Sweeney

et al. 2023

Preprint

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BackgroundEmerging evidence suggests that shortened, simplified treatment regimens for rifampicin-resistant tuberculosis (RR-TB) can achieve comparable end-of-treatment outcomes to longer regimens. We compared a 6-month regimen containing bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) to a standard of care strategy using a 9- or 18-month regimen depending on whether fluoroquinolone resistance (FQ-R) is detected on Drug Susceptibility Testing (DST).Methods and FindingsGenomic and associated demographic data were used to parameterize a mathematical model estimating long-term health outcomes and costs (2022 USD) for each treatment strategy for patients 15 years and older diagnosed with pulmonary RR-TB in Moldova, a country with a high burden of TB drug resistance. In this model individuals were followed over their lifetime, simulating the natural history of TB and associated treatment outcomes, as well as the process of acquiring resistance to each of 12 anti-TB drugs. Compared to the standard of care, 6 months of BPaLM was estimated to reduce lifetime costs by $3433 (95% Uncertainty Interval (UI): 1480, 5771) per individual, with a small non-significant reduction in quality adjusted life expectancy of 0.06 QALYs (95% UI: −0.33, 0.45). For those stopping moxifloxacin under the BPaLM regimen, continuing with BPaLC provided more QALYs at lower cost than continuing with BPaL alone. Such a regimen (6 months of BPaLM, where clofazimine is added in the event of moxifloxacin discontinuation) had a 92% chance of being cost-effective. With the exception of pretomanid and delamanid, 6 months of BPaLM either reduced or resulted in no significant change in the cumulative incidence of resistance to each drug. Sensitivity analyses showed 6 months of BPaLM to be cost-effective across a broad range of values for the relative effectiveness of the drug regimens and the proportion of the cohort with FQ-R.ConclusionsCompared to the standard of care, the implementation of short-course regimens like BPaLM could improve the cost-effectiveness of care for individuals diagnosed with RR-TB, particularly in settings where current long-course regimens are challenging to implement and afford. Further research may be warranted to explore the suitability of 6 months of BPaLM in specific national settings, including locations where DST capacity is limited.

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Update of drug-resistant tuberculosis treatment guidelines: A turning point

Cited by 32 publications

References 14 publications

Effectiveness of using a long-term individualized treatment regimen of tuberculosis with multiple drug resistance in elderly people with concomitant diseases

Effectiveness of using a long-term individualized treatment regimen of tuberculosis with multiple drug resistance in elderly people with concomitant diseases

Prevalence and epidemic pattern of ecdemic multidrug-resistant tuberculosis during 2012- 2022 in Hangzhou, China

Impact and cost-effectiveness of the 6-month BPaLM regimen for rifampicin-resistant tuberculosis: a mathematical modeling analysis

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