Drug recommendation for optimization on treatment outcome for MDR/RR-TB based on a multi-center, large scale, retrospective cohort study in China

ABSTRACT

Objective

With the change in drug-resistant pattern, MDR/RR-TB was faced with underlying changes in regimens. A multi-center, large-scale, retrospective study performed aims to provide a recommendation of drug selection on optimization of outcome for the patients.

Method

The study was conducted in six TB-specialized hospitals in China. Patients were included from 2018-2021 and followed up throughout the treatment. Using a multivarariable and propensity score-matched logistic regression analysis, we evaluated associations between outcomes and drug use, as well as clinical characteritics.

Results

Of 3112 patients, 74.29% had treatment sucess, 14.52% lost to follow-up, 9.67% failure, and 1.51% died. Treatment success was positively associated with Bedaquiline(Bdq), Linezolid(Lzd), and Cycloserin(Cs). Capreomycin(Cm) increased the risk of unfavorable outcomes. other drugs such as Amikacin(Amk) and clofazimine had no significant effect on outcomes. If isolates were susceptible to fluoroquinolones(FQs), FQs could decrease the risk of unfavorable outcomes.

Conclusions

The recommendation order for the treatment of MDR/RR-TB is Bdq, Lzd, and Cs. FQs were decreased in use intensity. Injection drugs, whether Amk or Cm, are not recommended.

KEYWORDS:

• Treatment outcome
• favorable outcome
• MDR/RR-TB
• treatment success
• risk factors

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors wish to thank all participants for their efforts.

Ethics statement

This study was approved by the Ethics Committee of Shanghai Pulmonary Hospital, Tongji University School of Medicine, the approval number was K20–430. The written informed consent was waived due to the retrospective study, but the patients’ privacy was fully protected from the study.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author.

Author contribution statement

All authors participated in the work concerning the patients included, data collected and statistic analysis, the study design, writing the manuscript. All authors read and approved the final submitted version.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2024.2303032.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China [82170006], the Shanghai Science and Technology Committee Fund [21Y11901000, 20ZR1446700], the Clinical Research Foundation of Shanghai Pulmonary Hospital [FKLY20017, SKPY2021003].