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Tuesday, 13 March 2018 00:31

New TBnet publication: Clinical Management of Multidrug-resistant Tuberculosis in 16 European Countries

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American Journal of Respiratory and Critical Care Medicine                                                                                                                                       Authors: Gunar Günther , Frank van Leth , Sofia Alexandru , Neus Altet , Korkut Avsar , Didi Bang , Raisa Barbuta , Graham Bothamley , Ana Ciobanu , Valeriu Crudu , Manfred Danilovits ,Martin Dedicoat , Raquel Duarte , Gina Gualano ,Heinke Kunst , Wiel de Lange , Vaira Leimane , Anne-Marie McLaughlin , Cecile Magis-Escurra , Inge Muylle ,Veronika Polcová , Cristina Popa , Rudolf Rumetshofer , Alena Skrahina , Varvara Solodovnikova , Victor Spinu ,Simon Tiberi , Piret Viiklepp , Christoph Lange, for TBNET                                                                                             Abstract                                                                                                                                                                                                                                            Background: 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. 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 WHO and alternative simplified definitions. Results: 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 days), 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 WHO outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include one 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 to individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by WHO outcome definitions. Read more here
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