Autor(es):
Guenther, G ; Leth, F ; Alexandru, S ; Altet, N ; Avsar, K ; Bang, D ; Barbuta, R ; Bothamley, G ; Ciobanu, A ; Crudu, V ; Danilovits, M ; Dedicoat, M ; Duarte, R ; Gualano, G ; Kunst, H ; Lange, W ; Leimane, V ; McLaughlin, AM ; Magis-Escurra, C ; Muylle, I ; Polcova, V ; Popa, C ; Rumetshofer, R ; Skrahina, A ; Solodovnikova, V ; Spinu, V ; Tiberi, S ; Viiklepp, P ; Lange, C
Data: 2018
Identificador Persistente: https://hdl.handle.net/10216/154084
Origem: Repositório Aberto da Universidade do Porto
Assunto(s): management; MDR-TB; outcome definitions; TBNET; extensively drug-resistant TB
Descrição
Rationale: 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.
