Treatment Outcomes of Patients With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis According to Drug Susceptibility Testing to First- and Second-line Drugs: An Individual Patient Data Meta-analysis

作者：Mayara Lisboa Bastos, Hamidah Hussain, Karin Weyer, Lourdes García‐García, Vaira Leimane, Chi Chiu Leung, Masahiro Narita, José M. Peña, Alfredo Ponce‐de‐León, Kwonjune J. Seung, K. Shean, José Sifuentes‐Osornio, Martie van der Walt, Tjip S. van der Werf, Wing Wai Yew, Dick Menzies, for the Collaborative Group for Meta-analysis of Individual Patient Data in MDR-TB, Shama D. Ahuja, David Ashkin, Mauricio Avendaño, Rabin Banerjee, Melissa Bauer, M. C. Becerra, Andrea Benedetti, M. Burgos, Rosella Centis, Edward D. Chan, Chen‐Yuan Chiang, Frank Cobelens, Helen Cox, Lia D’Ambrosio, Wiel C.M. de Lange, Kathryn DeRiemer, Donald A. Enarson, Dennis Falzon, Katie L. Flanagan, Jennifer Flood, Neel R. Gandhi, L. Garcia-Garcia, Reuben Granich, Maria-Graciela Hollm-Delgado, Timothy H. Holtz, Philip C. Hopewell, M D Iseman, Leah G. Jarlsberg, Salmaan Keshavjee, H. R. Kim, Won‐Jung Koh, J. Lancaster, Christoph Lange, V. Leimane, Chi Chiu Leung, Joanne C Li, Dick Menzies, Giovanni Battista Migliori, C. M. Mitnick, Masahiro Narita, Eva Nathanson, Ronel Odendaal, Philly O'Riordan, Madhukar Pai, Domingo Palmero, S. K. Park, Geoffrey Pasvol, José M. Peña, Carlos Pérez-Guzmán, Alfredo Ponce‐de‐León, M. I. D. Quelapio, Hoang Thi Quy, Vija Riekstiņa, J. Robert, Sarah Royce, M Salim, H. Simon Schaaf, Kwonjune J. Seung, Lisa Shah, K. Shean, Tae Sun Shim, Steven S. Shin, Yoshimasa Shiraishi, José Sifuentes‐Osornio, Giovanni Sotgiu, Matthew Strand, Sook Whan Sung, Payam Tabarsi, Thelma E. Tupasi, Mario H. Vargas, Richard van Altena, Martie van der Walt, Tjip S. van der Werf, Piret Viiklepp, Janice Westenhouse, Wing Wai Yew, Jae‐Joon Yim · 发表于：Clinical Infectious Diseases · 年份：2014 · DOI：10.1093/cid/ciu619 · 被引用次数：139 · 研究领域：Tuberculosis Research and Epidemiology、Drug-Induced Hepatotoxicity and Protection、Pharmacovigilance and Adverse Drug Reactions

BACKGROUND: Individualized treatment for multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis depends upon reliable and valid drug susceptibility testing (DST) for pyrazinamide, ethambutol, and second-line tuberculosis drugs. However, the reliability of these tests is uncertain, due to unresolved methodological issues. We estimated the association of DST results for pyrazinamide, ethambutol, and second-line drugs with treatment outcomes in patients with MDR tuberculosis and XDR tuberculosis. METHODS: We conducted an analysis of individual patient data assembled from 31 previously published cohort studies of patients with MDR and XDR tuberculosis. We used data on patients' clinical characteristics including DST results, treatment received, outcomes, and laboratory methods in each center. RESULTS: DST methods and treatment regimens used in different centers varied considerably. Among 8955 analyzed patients, in vitro susceptibility to individual drugs was consistently and significantly associated with higher odds of treatment success (compared with resistance to the drug), if that drug was used in the treatment regimen. Various adjusted and sensitivity analyses suggest that this was not explained by confounding. The adjusted odds of treatment success for ethambutol, pyrazinamide, and the group 4 drugs ranged from 1.7 to 2.3, whereas for second-line injectables and fluoroquinolones, odds ranged from 2.4 to 4.6. CONCLUSIONS: DST for ethambutol, ...