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Eur Respir J. 2020;56(5):13993003.01394-2020.

Changes in treatment for multidrug-resistant tuberculosis according to national income.

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제1저자 곽낙원 · 교신저자 임재준

소속 (11)
  1. Dept of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea.
  2. Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre Research Institute, McGill University, Montreal, QC, Canada.
  3. Dept of Academic Affairs, National Jewish Health, Denver, CO, USA.
  4. Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
  5. Global Tuberculosis Program, World Health Organization, Geneva, Switzerland.
  6. Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
  7. German Center for Infection Research, Clinical Tuberculosis Unit, Borstel, Germany.
  8. Respiratory Medicine and International Health, University of Luebeck, Luebeck, Germany.
  9. Dept of Medicine, Karolinska Institute, Stockholm, Sweden.
  10. International Tuberculosis Research Center, Seoul, South Korea.
  11. Dept of Pulmonary Diseases, Medical University - Sofia, Hospital of Respiratory Diseases "St. Sofia", Sofia, Bulgaria.

Abstract

The aim of this study was to analyse temporal changes in treatments for and outcomes of multidrug-resistant (MDR)/rifampin-resistant (RR)-tuberculosis (TB) in the context of national economic status.We analysed data collected by the Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB Treatment on MDR/RR-TB patients from 37 countries. The data were stratified by three national income levels (low-/lower-middle, upper-middle and high) and grouped by time of treatment initiation (2001-2003, 2004-2006, 2007-2009, 2010-2012 and 2013-2015). Temporal trends over the study period were analysed. The probability of treatment success in different income groups over time was calculated using generalised linear mixed models with random effects.In total, 9036 patients were included in the analysis. Over the study period, use of group A drugs (levofloxacin/moxifloxacin, bedaquiline and linezolid) recommended by the World Health Organization increased and treatment outcomes improved in all income groups. Between 2001-2003 and 2013-2015, treatment success rates increased from 60% to 78% in low-/lower-middle-income countries, from 40% to 67% in upper-middle-income countries, and from 73% to 81% in high-income countries. In earlier years, the probability of treatment success in upper-middle-income countries was lower than that in low-/lower-middle-income countries, but no difference was observed after 2010. However, high-income countries had persistently higher probability of treatment success compared to upper-middle income countries.Improved treatment outcomes and greater uptake of group A drugs were observed over time for patients with MDR/RR-TB at all income levels. However, treatment outcomes are still unsatisfactory, especially in upper-middle-income countries.

Copyright ©ERS 2020.

Conflict of interest statement

Conflict of interest: N. Kwak has nothing to disclose. Conflict of interest: N. Winters has nothing to disclose. Conflict of interest: J.R. Campbell has nothing to disclose. Conflict of interest: E.D. Chan has nothing to disclose. Conflict of interest: M. Gegia has nothing to disclose. Conflict of interest: C. Lange reports personal fees for lectures from Chiesi, Gilead, Janssen, Lucane, Novartis, Oxoid, Berlin Chemie and Thermofisher, personal fees for advisory board work from Oxford Immunotec, outside the submitted work. Conflict of interest: M. Lee has nothing to disclose. Conflict of interest: V. Milanov has nothing to disclose. Conflict of interest: D. Menzies has nothing to disclose. Conflict of interest: J-J. Yim received donations of linezolid (Zyvox) from Pfizer Inc. and Delamanid (Deltyba) from Otsuka Pharmaceutical Co. and served as principal investigator on clinical trials.

그 밖의 정보
출판 형태
Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't
저널
The European respiratory journal · eISSN 1399-3003
전자 출판
2020-11-05
MeSH
Antitubercular Agents* / therapeutic use · Humans · Linezolid · Moxifloxacin · Rifampin · Tuberculosis, Multidrug-Resistant* / drug therapy / epidemiology
Substances
Antitubercular Agents · Linezolid · Moxifloxacin · Rifampin
연구비
CIHR FRD331745