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Kho S, Seung KJ, Huerga H, Bastard M, Khan PY, Mitnick CD, Rich ML, Islam S, Zhizhilashvili D, Yeghiazaryan L, Nikolenko EN, Zarli K, Adnan S, Salahuddin N, Ahmed S, Vargas ZHR, Bekele A, Shaimerdenova A, Tamirat M, Gelin A, Vilbrun SC, Hewison C, Khan U, Franke M. Sputum culture reversion in longer treatments with bedaquiline, delamanid, and repurposed drugs for drug-resistant tuberculosis. Nat Commun 2024; 15:3927. [PMID: 38724531 PMCID: PMC11082252 DOI: 10.1038/s41467-024-48077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Sputum culture reversion after conversion is an indicator of tuberculosis (TB) treatment failure. We analyze data from the endTB multi-country prospective observational cohort (NCT03259269) to estimate the frequency (primary endpoint) among individuals receiving a longer (18-to-20 month) regimen for multidrug- or rifampicin-resistant (MDR/RR) TB who experienced culture conversion. We also conduct Cox proportional hazard regression analyses to identify factors associated with reversion, including comorbidities, previous treatment, cavitary disease at conversion, low body mass index (BMI) at conversion, time to conversion, and number of likely-effective drugs. Of 1,286 patients, 54 (4.2%) experienced reversion, a median of 173 days (97-306) after conversion. Cavitary disease, BMI < 18.5, hepatitis C, prior treatment with second-line drugs, and longer time to initial culture conversion were positively associated with reversion. Reversion was uncommon. Those with cavitary disease, low BMI, hepatitis C, prior treatment with second-line drugs, and in whom culture conversion is delayed may benefit from close monitoring following conversion.
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Affiliation(s)
- Sooyeon Kho
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Kwonjune J Seung
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Partners in Health, 800 Boylston Street Suite 300, Boston, MA, USA
| | | | | | - Palwasha Y Khan
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Interactive Research and Development Global, Singapore, Singapore
| | - Carole D Mitnick
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Partners in Health, 800 Boylston Street Suite 300, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael L Rich
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Partners in Health, 800 Boylston Street Suite 300, Boston, MA, USA
| | | | | | | | | | - Khin Zarli
- Médecins sans Frontières, Yangon, Myanmar
| | - Sana Adnan
- Indus Hospital and Health Network, Karachi, Pakistan
| | | | - Saman Ahmed
- Interactive Research and Development, Karachi, Pakistan
| | | | - Amsalu Bekele
- Department of Internal Medicine, Tikur Anbessa Specialized Hospital and Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | | | | | - Stalz Charles Vilbrun
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Uzma Khan
- Interactive Research and Development Global, Singapore, Singapore
| | - Molly Franke
- Partners in Health, 800 Boylston Street Suite 300, Boston, MA, USA.
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Rodriguez CA, Lodi S, Horsburgh CR, Mitnick CD, Bastard M, Huerga H, Khan U, Rich M, Seung KJ, Atwood S, Manzur-ul-Alam M, Melikyan N, Mpinda S, Myint Z, Naidoo Y, Petrosyan O, Salahuddin N, Sarfaraz S, Vilbrun SC, Yae K, Achar J, Ahmed S, Algozhina E, Beauchamp J, de Guadelupe Perea Moreno S, Gulanbaeva M, Gergedava M, Indah Sari CY, Hewison C, Khan P, Franke MF. Comparative effectiveness of adding delamanid to a multidrug-resistant tuberculosis regimen comprised of three drugs likely to be effective. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000818. [PMID: 37115740 PMCID: PMC10146539 DOI: 10.1371/journal.pgph.0000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
Clarity about the role of delamanid in longer regimens for multidrug-resistant TB is needed after discordant Phase IIb and Phase III randomized controlled trial results. The Phase IIb trial found that the addition of delamanid to a background regimen hastened culture conversion; the results of the Phase III trial were equivocal. We evaluated the effect of adding delamanid for 24 weeks to three-drug MDR/RR-TB regimens on two- and six-month culture conversion in the endTB observational study. We used pooled logistic regression to estimate the observational analogue of the intention-to-treat effect (aITT) adjusting for baseline confounders and to estimate the observational analogue of the per-protocol effect (aPP) using inverse probability of censoring weighting to control for time-varying confounding. At treatment initiation, 362 patients received three likely effective drugs (delamanid-free) or three likely effective drugs plus delamanid (delamanid-containing). Over 80% of patients received two to three Group A drugs (bedaquiline, linezolid, moxifloxacin/levofloxacin) in their regimen. We found no evidence the addition of delamanid to a three-drug regimen increased two-month (aITT relative risk: 0.90 (95% CI: 0.73-1.11), aPP relative risk: 0.89 (95% CI: 0.66-1.21)) or six-month culture conversion (aITT relative risk: 0.94 (95% CI: 0.84, 1.02), aPP relative risk: 0.93 (95% CI: 0.83, 1.04)). In regimens containing combinations of three likely effective, highly active anti-TB drugs the addition of delamanid had no discernible effect on culture conversion at two or six months. As the standard of care for MDR/RR-TB treatment becomes more potent, it may become increasingly difficult to detect the benefit of adding a single agent to standard of care MDR/RR-TB regimens. Novel approaches like those implemented may help account for background regimens and establish effectiveness of new chemical entities.
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Affiliation(s)
- Carly A. Rodriguez
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - C. Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Carole D. Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | | | | | - Uzma Khan
- Interactive Research and Development Global, Singapore, Singapore
| | - Michael Rich
- Partners In Health, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Kwonjune J. Seung
- Partners In Health, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Sidney Atwood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | - Zaw Myint
- National Tuberculosis Program, Ministry of Health, Yangon, Myanmar
| | - Yugandran Naidoo
- Interactive Research and Development, Johannesburg, South Africa
| | | | | | | | | | | | - Jay Achar
- Médecins Sans Frontières, United Kingdom
| | - Saman Ahmed
- Interactive Research and Development, Karachi, Pakistan
| | | | | | | | | | | | | | | | - Palwasha Khan
- Interactive Research and Development Global, Singapore, Singapore
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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3
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Putra ON, Yulistiani Y, Soedarsono S, Subay S. Favorable outcome of individual regimens containing bedaquiline and delamanid in drug-resistant tuberculosis: A systematic review. Int J Mycobacteriol 2023; 12:1-9. [PMID: 36926755 DOI: 10.4103/ijmy.ijmy_217_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background Drug-resistant tuberculosis (DR-TB) is a public health concern that is difficult to treat, requiring long and complex treatment with highly effective drugs. Bedaquiline and/or delamanid have already shown promising outcomes in patients with DR-TB, increasing the rate of culture conversion and lowering TB-related mortality. Methods We comprehensively searched and evaluated the effectiveness of individual regimens containing bedaquiline and delamanid on culture conversion and treatment success. We assessed for quality either observational or experimental studies. Results We identified 14 studies that met the inclusion criteria using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart with 12 observational and 2 experimental studies. Of 1691 DR-TB patients enrolled in the included studies, 1407 of them concomitantly received regimens containing bedaquiline and delamanid. Overall multidrug resistant (MDR), preextensively drug resistant (XDR), and XDR-TB were seen in 21.4%, 44.1%, and 34.5%, respectively. Of 14 studies, 8 of them reported favorable outcomes including sputum culture conversion and cure rate at the end of treatment, meanwhile 6 studies only reported sputum culture conversion. Sputum culture conversion at the end of the 6th month was 63.6%-94.7% for observational studies, and 87.6%-95.0% for experimental studies. The favorable outcome at the end of treatment was 67.5%-91.4%. With high pre-XDR and XDR cases among DR-TB patients with limited treatment options, regimens containing bedaquiline and delamanid provide successful treatment. Conclusion In DR-TB patients receiving regimens containing bedaquiline and delamanid, favorable outcomes were high including sputum conversion and cure rate.
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Affiliation(s)
- Oki Nugraha Putra
- Doctoral Program of Pharmacy, Faculty of Pharmacy, Airlangga University; Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
| | - Yulistiani Yulistiani
- Doctoral Program of Pharmacy, Faculty of Pharmacy, Airlangga University, Surabaya, Indonesia
| | - Soedarsono Soedarsono
- Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University; Department of Pulmonology and Respiratory Medicine, Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Susi Subay
- Department of Pulmonology and Respiratory Medicine, Dr. Soetomo Hospital, Surabaya, Indonesia
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Santos JM, Fachi MM, Beraldi-Magalhães F, Böger B, Junker AM, Domingos EL, Imazu P, Fernandez-Llimos F, Tonin FS, Pontarolo R. Systematic review with network meta-analysis on the treatments for latent tuberculosis infection in children and adolescents. J Infect Chemother 2022; 28:1645-1653. [PMID: 36075488 DOI: 10.1016/j.jiac.2022.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/15/2022] [Accepted: 08/26/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND We aimed to synthesize the evidence on the efficacy and safety of different treatment regimens for latent tuberculosis infection (LTBI) in children and adolescents. METHODS A systematic review with network meta-analysis was performed (CRD142933). Searches were conducted in Pubmed and Scopus (Nov-2021). Randomized controlled trials comparing treatments for LTBI (patients up to 15 years), and reporting data on the incidence of the disease, death or adverse events were included. Networks using the Bayesian framework were built for each outcome of interest. Results were reported as odds ratio (OR) with 95% credibility intervals (CrI). Rank probabilities were calculated via the surface under the cumulative ranking analysis (SUCRA) (Addis-v.1.16.8). GRADE approach was used to rate evidence's certainty. RESULTS Seven trials (n = 8696 patients) were included. Placebo was significantly associated with a higher incidence of tuberculosis compared to all active therapies. Combinations of isoniazid (15-25 mg/kg/week) plus rifapentine (300-900 mg/week), followed by isoniazid plus rifampicin (10 mg/kg/day) were ranked as best approaches with lower probabilities of disease incidence (10% and 19.5%, respectively in SUCRA) and death (20%). Higher doses of isoniazid monotherapy were significantly associated to more deaths (OR 18.28, 95% ICr [1.02, 48.60] of 4-6 mg/kg/day vs. 10 mg/kg/3x per week). CONCLUSIONS Combined therapies of isoniazid plus rifapentine or rifampicin for short-term periods should be used as the first-line approach for treating LTBI in children and adolescents. The use of long-term isoniazid as monotherapy and at higher doses should be avoided for this population.
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Affiliation(s)
- Josiane M Santos
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Mariana M Fachi
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | | | - Beatriz Böger
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Allan M Junker
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Eric L Domingos
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Priscila Imazu
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil.
| | - Fernando Fernandez-Llimos
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil; H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal.
| | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Paraná, Curitiba, Brazil.
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Edwards BD, Field SK. The Struggle to End a Millennia-Long Pandemic: Novel Candidate and Repurposed Drugs for the Treatment of Tuberculosis. Drugs 2022; 82:1695-1715. [PMID: 36479687 PMCID: PMC9734533 DOI: 10.1007/s40265-022-01817-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
This article provides an encompassing review of the current pipeline of putative and developed treatments for tuberculosis, including multidrug-resistant strains. The review has organized each compound according to its site of activity. To provide context, mention of drugs within current recommended treatment regimens is made, thereafter followed by discussion on recently developed and upcoming molecules at established and novel targets. The review is designed to provide a clinically applicable understanding of the compounds that are deemed most currently relevant, including those already under clinical study and those that have shown promising pre-clinical results. An extensive review of the efficacy and safety data for key contemporary drugs already incorporated into treatment regimens, such as bedaquiline, pretomanid, and linezolid, is provided. The three levels of the bacterial cell wall (mycolic acid, arabinogalactan, and peptidoglycan layers) are highlighted and important compounds designed to target each layer are delineated. Amongst others, the highly optimistic and potent anti-mycobacterial activity of agents such as BTZ-043, PBTZ 169, and OPC-167832 are emphasized. The evolving spectrum of oxazolidinones, such as sutezolid, delpazolid, and TBI-223, all aiming to exceed the efficacy achieved with linezolid yet offer a safer alternative to the potential toxicity, are reviewed. New and exciting prospective agents with novel mechanisms of impact against TB, including 3-aminomethyl benzoxaboroles and telacebec, are underscored. We describe new diaryloquinolines in development, striving to build on the immense success of bedaquiline. Finally, we discuss some of these compounds that have shown encouraging additive or synergistic benefit when used in combination, providing some promise for the future in treating this ancient scourge.
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Affiliation(s)
- Brett D Edwards
- Division of Infectious Diseases and Tuberculosis Services, Alberta Health Services, Department of Medicine, Cumming School of Medicine, University of Calgary, Peter Lougheed Centre, 3500, 26 Avenue NE, Calgary, AB, T1Y6J4, Canada.
| | - Stephen K Field
- Division of Infectious Diseases and Tuberculosis Services, Alberta Health Services, Department of Medicine, Cumming School of Medicine, University of Calgary, Peter Lougheed Centre, 3500, 26 Avenue NE, Calgary, AB, T1Y6J4, Canada
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6
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Rodriguez CA, Lodi S, Horsburgh CR, Bastard M, Hewison C, Huerga H, Khan M, Khan PY, Khan U, Oyewusi L, Padayachee S, Mitnick CD, Franke MF. Selection bias in multidrug-resistant tuberculosis cohort studies assessing sputum culture conversion. PLoS One 2022; 17:e0276457. [PMID: 36355658 PMCID: PMC9648724 DOI: 10.1371/journal.pone.0276457] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Conversion of sputum culture from positive to negative for M. tuberculosis is a key indicator of treatment response. An initial positive culture is a pre-requisite to observe conversion. Consequently, patients with a missing or negative initial culture are excluded from analyses of conversion outcomes. To identify the initial, or "baseline" culture, researchers must define a sample collection interval. An interval extending past treatment initiation can increase sample size but may introduce selection bias because patients without a positive pre-treatment culture must survive and remain in care to have a culture in the post-treatment interval. METHODS We used simulated data and data from the endTB observational cohort to investigate the potential for bias when extending baseline culture intervals past treatment initiation. We evaluated bias in the proportion with six-month conversion. RESULTS In simulation studies, the potential for bias depended on the proportion of patients missing a pre-treatment culture, proportion with conversion, proportion culture positive at treatment initiation, and proportion of patients missing a pre-treatment culture who would have been observed to be culture positive, had they had a culture. In observational data, the maximum potential for bias when reporting the proportion with conversion reached five percentage points in some sites. CONCLUSION Extending the allowable baseline interval past treatment initiation may introduce selection bias. If investigators choose to extend the baseline collection interval past treatment initiation, the proportion missing a pre-treatment culture and the number of deaths and losses to follow up during the post-treatment allowable interval should be clearly enumerated.
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Affiliation(s)
- Carly A. Rodriguez
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - C. Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | | | | | - Munira Khan
- THINK TB & HIV Investigative Network, Durban, South Africa
| | - Palwasha Y. Khan
- Interactive Research and Development Global, Singapore, Singapore
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uzma Khan
- Interactive Research and Development Global, Singapore, Singapore
| | | | | | - Carole D. Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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7
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Fu L, Weng T, Sun F, Zhang P, Li H, Li Y, Yang Q, Cai Y, Zhang X, Liang H, Chen X, Wang Z, Liu L, Zhang W, Deng G. Insignificant difference in culture conversion between bedaquiline-containing and bedaquiline-free all-oral short regimens for multidrug-resistant tuberculosis. Int J Infect Dis 2021; 111:138-147. [PMID: 34454119 DOI: 10.1016/j.ijid.2021.08.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) patients have been suffering long, ineffective, and toxic treatment until short-course injectable-free regimens emerged. However, the new WHO-recommended regimens might be less feasible in the real-world setting. Here, we evaluated two optimized all-oral short-course regimens in China. METHODS From April 2019 to August 2020, we conducted a prospective nonrandomized controlled trial and consecutively included 103 MDR-TB patients diagnosed with pulmonary MDR-TB in Shenzhen, China. A 4-5 drug regimen of 9-12 months was tailored to the strain's resistance patterns, patients' affordability, and tolerance to drugs. This was an interim analysis, focusing on the early treatment period. RESULTS 53.4% (55/103) of patients were prescribed linezolid, fluoroquinolone (FQ), clofazimine, cycloserine, and pyrazinamide, followed by a regimen in which clofazimine was replaced by bedaquiline (35/103, 34.0%). The culture conversion rate was 83.1% and 94.4% at two and four months, respectively, with no significant difference between bedaquiline-free and bedaquiline-containing cases and between FQ-susceptible and FQ-resistant cases. Among 41 patients who completed treatment, 40 (97.6%) patients had a favorable outcome and no relapse was observed. Peripheral neuropathy and arthralgia/myalgia were the most frequent AEs (56.3%, 58/103). 18 AEs caused permanent discontinuation of drugs, mostly due to pyrazinamide and linezolid. CONCLUSION Optimized all-oral short-course regimens showed satisfactory efficacy and safety in early treatment stage. Further research is needed to confirm these results.
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Affiliation(s)
- Liang Fu
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Taoping Weng
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Feng Sun
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Peize Zhang
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Hui Li
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Yang Li
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Qianting Yang
- Guangdong Key Lab for Diagnosis &Treatment of Emerging Infectious Disease, Shenzhen Third People's Hospital, National clinical research center for infectious disease, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Yi Cai
- Department of Pathogen Biology, Guangdong Key Laboratory of Regional Immunity and Diseases, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Xilin Zhang
- The Fourth People's Hospital of Foshan, Foshan, 528000, China
| | - Hancheng Liang
- Tuberculosis Diseases Department Two, The Sixth People's Hospital of Dongguan, Dongguan, 523000, China
| | - Xinchun Chen
- Department of Pathogen Biology, Guangdong Key Laboratory of Regional Immunity and Diseases, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Zhaoqin Wang
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Lei Liu
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China.
| | - Wenhong Zhang
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Guofang Deng
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China.
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8
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Rodriguez CA, Brooks MB, Aibana O, Mitnick CD, Franke MF. Sputum culture conversion definitions and analytic practices for multidrug-resistant TB. Int J Tuberc Lung Dis 2021; 25:596-598. [PMID: 34183109 PMCID: PMC8259120 DOI: 10.5588/ijtld.21.0090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - M B Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - O Aibana
- Department of Internal Medicine, University of Texas Health Science Center - Houston, McGovern Medical School, Houston, TX, USA
| | - C D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
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Oelofse S, Esmail A, Diacon AH, Conradie F, Olayanju O, Ngubane N, Howell P, Everitt D, Crook AM, Mendel CM, Wills GH, Olugbosi M, del Parigi A, Sun E, Calatroni A, Spigelman M, Dheda K. Pretomanid with bedaquiline and linezolid for drug-resistant TB: a comparison of prospective cohorts. Int J Tuberc Lung Dis 2021; 25:453-460. [PMID: 34049607 PMCID: PMC8171246 DOI: 10.5588/ijtld.21.0035] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: There are no data comparing the 6-9 month oral three-drug Nix regimen (bedaquiline, pretomanid and linezolid [BPaL]) to conventional regimens containing bedaquiline (B, BDQ) and linezolid (L, LZD).METHODS: Six-month post end-of-treatment outcomes were compared between Nix-TB (n = 109) and 102 prospectively recruited extensively drug-resistant TB patients who received an ˜18-month BDQ-based regimen (median of 8 drugs). A subset of patients received BDQ and LZD (n = 86), and a subgroup of these (n = 75) served as individually matched controls in a pairwise comparison to determine differences in regimen efficacy.RESULTS: Favourable outcomes (%) were significantly better with BPaL than with the B-L-based combination regimen (98/109, 89.9% vs. 56/86, 65.1%; adjusted relative risk ratio [aRRR] 1.35; P < 0.001) and in the matched pairwise analysis (67/75, 89.3% vs. 48/75, 64.0%; aRRR 1.39; P = 0.001), despite significantly higher baseline bacterial load and prior second-line drug exposure in the BPaL cohort. Time to culture conversion (P < 0.001), time to unfavourable outcome (P < 0.01) and time to death (P < 0.03) were significantly better or lower with BPaL than the B-L-based combinations.CONCLUSION: The BPaL regimen (and hence substitution of multiple other drugs by pretomanid and/or higher starting-dose LZD) may improve outcomes in drug-resistant TB patients with poor prognostic features. However, prospective controlled studies are required to definitively answer this question.
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Affiliation(s)
- S. Oelofse
- Centre for Lung Infection and Immunity, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - A. Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - A. H. Diacon
- Task Applied Science and Stellenbosch University, Cape Town, South Africa
| | - F. Conradie
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
,Sizwe Tropical Disease Hospital, Sandringham, South Africa
| | - O. Olayanju
- Centre for Lung Infection and Immunity, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - N. Ngubane
- Task Applied Science and Stellenbosch University, Cape Town, South Africa
,King DinuZulu Hospital Complex, Durban, South Africa
| | - P. Howell
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
,Sizwe Tropical Disease Hospital, Sandringham, South Africa
| | | | - A. M. Crook
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - G. H. Wills
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | | | - E. Sun
- TB Alliance, New York, NY, USA
| | - A. Calatroni
- Rho Federal Systems Division, Inc., Durham, NC, USA
| | | | - K. Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town (UCT), Cape Town, South Africa
,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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10
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Meyvisch P, Alonso A, Van der Elst W, Molenberghs G. On the relationship between association and surrogacy when both the surrogate and true endpoint are binary outcomes. Stat Med 2020; 39:3867-3878. [PMID: 32875590 DOI: 10.1002/sim.8698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/14/2020] [Accepted: 06/25/2020] [Indexed: 11/12/2022]
Abstract
The relationship between association and surrogacy has been the focus of much debate in the surrogate marker literature. Recently, the individual causal association (ICA) has been introduced as a metric of surrogacy in the causal inference framework, when both the surrogate and the true endpoint are normally distributed and when both are binary. Earlier work on the normal case has demonstrated that, although the ICA and the adjusted association are related metrics, their relationship strongly depends on unidentifiable parameters and, consequently, the association between both endpoints conveys little information on the validity of the surrogate. In addition, in the normal setting, the magnitude of the ICA does not depend on the mean of the outcomes. The latter implies that identifiable parameters such as mean responses and treatment effects provide no information on the validity of the surrogate. In the present work it is shown that this is fundamentally different in the binary case. We demonstrate that the observed association between the outcomes as well as the success rates in both treatment groups are quite predictive for the ICA. It is shown that finding a good surrogate will be more likely when the association between the endpoints is large, there are sizeable treatment effects and the success rates for both endpoints are similar in both treatment groups. These results are demonstrated using extensive simulations and illustrated on a case study in multi-drug resistant tuberculosis.
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Affiliation(s)
- Paul Meyvisch
- Galapagos NV, Mechelen, Belgium.,I-BioStat, KU Leuven, Leuven, Belgium.,I-BioStat, Universiteit Hasselt, Diepenbeek, Belgium
| | | | - Wim Van der Elst
- The Janssen Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium
| | - Geert Molenberghs
- I-BioStat, KU Leuven, Leuven, Belgium.,I-BioStat, Universiteit Hasselt, Diepenbeek, Belgium
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