PLoS ONE (Jan 2023)

Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment.

  • Nicholas Winters,
  • Mireille E Schnitzer,
  • Jonathon R Campbell,
  • Susannah Ripley,
  • Carla Winston,
  • Rada Savic,
  • Nafees Ahmad,
  • Gregory Bisson,
  • Keertan Dheda,
  • Ali Esmail,
  • Medea Gegia,
  • Ignacio Monedero,
  • Margareth Pretti Dalcolmo,
  • Denise Rodrigues,
  • Rupak Singla,
  • Jae-Joon Yim,
  • Dick Menzies

DOI
https://doi.org/10.1371/journal.pone.0292106
Journal volume & issue
Vol. 18, no. 10
p. e0292106

Abstract

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ObjectiveStudying treatment duration for rifampicin-resistant and multidrug-resistant tuberculosis (MDR/RR-TB) using observational data is methodologically challenging. We aim to present a hypothesis generating approach to identify factors associated with shorter duration of treatment.Study design and settingWe conducted an individual patient data meta-analysis among MDR/RR-TB patients restricted to only those with successful treatment outcomes. Using multivariable linear regression, we estimated associations and their 95% confidence intervals (CI) between the outcome of individual deviation in treatment duration (in months) from the mean duration of their treatment site and patient characteristics, drug resistance, and treatments used.ResultsOverall, 6702 patients with successful treatment outcomes from 84 treatment sites were included. We found that factors commonly associated with poor treatment outcomes were also associated with longer treatment durations, relative to the site mean duration. Use of bedaquiline was associated with a 0.51 (95% CI: 0.15, 0.87) month decrease in duration of treatment, which was consistent across subgroups, while MDR/RR-TB with fluoroquinolone resistance was associated with 0.78 (95% CI: 0.36, 1.21) months increase.ConclusionWe describe a method to assess associations between clinical factors and treatment duration in observational studies of MDR/RR-TB patients, that may help identify patients who can benefit from shorter treatment.