Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries.
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Published version
Embargoed until: 5555-01-01
Embargoed until: 5555-01-01
Pagination
379 - 386
Publisher
DOI
10.1164/rccm.201710-2141OC
Journal
Am J Respir Crit Care Med
ISSN
1073-449X
Metadata
Show full item recordAbstract
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.