1
|
Lotia Farrukh I, Lachenal N, Adenov MM, Ahmed S, Algozhin Y, Coutisson S, Garavito ES, Hewison C, Holtzman D, Huerga H, Janmohamed A, Khan PY, Jacques GL, Lomtadze N, Melikyan N, Mitnick CD, Mussabekova G, Osso E, Perea S, Putri FA, Rashidov M, Rich ML, Sakhabutdinova Y, Seung KJ, Stambekova A, Vásquez DV, Franke MF, Khan U. Pregnancy and Birth Outcomes in Patients With Multidrug-Resistant Tuberculosis Treated With Regimens That Include New and Repurposed Drugs. Clin Infect Dis 2024; 78:144-148. [PMID: 37606512 PMCID: PMC10810705 DOI: 10.1093/cid/ciad445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Indexed: 08/23/2023] Open
Abstract
Among 43 pregnant women receiving multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment with bedaquiline and/or delamanid, 98% had favorable treatment outcomes. Of 31 continued pregnancies, 81% had live births with no reported malformations, and 68% of neonates had normal birth weights. Effective MDR/RR-TB treatment during pregnancy can improve maternal outcomes without harming neonates.
Collapse
Affiliation(s)
| | - Nathalie Lachenal
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | - Malik M Adenov
- National Scientific Center of Phthisiopulmonology, Ministry of Health, Republic of Kazakhstan, Almaty, Kazakhstan
| | - Saman Ahmed
- Interactive Research and Development Pakistan, Karachi, Pakistan
| | | | - Sylvine Coutisson
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | | | | | | | - Helena Huerga
- Field Epidemiology Department, Epicentre, Paris, France
| | | | - Palwasha Y Khan
- Interactive Research and Development Pakistan, Karachi, Pakistan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Nino Lomtadze
- Surveillance and Strategic Planning, Ministry of Health, Tbilisi, Georgia
| | - Nara Melikyan
- Field Epidemiology Department, Epicentre, Yerevan, Armenia
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Gulnaz Mussabekova
- National Scientific Center of Phthisiopulmonology, Ministry of Health, Republic of Kazakhstan, Almaty, Kazakhstan
| | - Elna Osso
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Perea
- Socios En Salud Sucursal Peru, Lima, Peru
| | | | | | - Michael L Rich
- Partners In Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Kwonjune J Seung
- Partners In Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Uzma Khan
- Interactive Research and Development Pakistan, Karachi, Pakistan
| |
Collapse
|
2
|
Velásquez GE, Brooks MB, Coit JM, Pertinez H, Vargas Vásquez D, Sánchez Garavito E, Calderón RI, Jiménez J, Tintaya K, Peloquin CA, Osso E, Tierney DB, Seung KJ, Lecca L, Davies GR, Mitnick CD. Efficacy and Safety of High-Dose Rifampin in Pulmonary Tuberculosis. A Randomized Controlled Trial. Am J Respir Crit Care Med 2019; 198:657-666. [PMID: 29954183 DOI: 10.1164/rccm.201712-2524oc] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE We examined whether increased rifampin doses could shorten standard therapy for tuberculosis without increased toxicity. OBJECTIVES To assess the differences across three daily oral doses of rifampin in change in elimination rate of Mycobacterium tuberculosis in sputum and frequency of rifampin-related adverse events. METHODS We conducted a blinded, randomized, controlled phase 2 clinical trial of 180 adults with new smear-positive pulmonary tuberculosis, susceptible to isoniazid and rifampin. We randomized 1:1:1 to rifampin at 10, 15, and 20 mg/kg/d during the intensive phase. We report the primary efficacy and safety endpoints: change in elimination rate of M. tuberculosis log10 colony-forming units and frequency of grade 2 or higher rifampin-related adverse events. We report efficacy by treatment arm and by primary (area under the plasma concentration-time curve [AUC]/minimum inhibitory concentration [MIC]) and secondary (AUC) pharmacokinetic exposure. MEASUREMENTS AND MAIN RESULTS Each 5-mg/kg/d increase in rifampin dose resulted in differences of -0.011 (95% confidence interval, -0.025 to +0.002; P = 0.230) and -0.022 (95% confidence interval, -0.046 to -0.002; P = 0.022) log10 cfu/ml/d in the modified intention-to-treat and per-protocol analyses, respectively. The elimination rate in the per-protocol population increased significantly with rifampin AUC0-6 (P = 0.011) but not with AUC0-6/MIC99.9 (P = 0.053). Grade 2 or higher rifampin-related adverse events occurred with similar frequency across the three treatment arms: 26, 31, and 23 participants (43.3%, 51.7%, and 38.3%, respectively) had at least one event (P = 0.7092) up to 4 weeks after the intensive phase. Treatment failed or disease recurred in 11 participants (6.1%). CONCLUSIONS Our findings of more rapid sputum sterilization and similar toxicity with higher rifampin doses support investigation of increased rifampin doses to shorten tuberculosis treatment. Clinical trial registered with www.clinicaltrials.gov (NCT 01408914) .
Collapse
Affiliation(s)
- Gustavo E Velásquez
- 1 Division of Infectious Diseases and.,2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Meredith B Brooks
- 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Julia M Coit
- 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Henry Pertinez
- 3 Institute of Infection and Global Health and.,4 Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Judith Jiménez
- 7 Partners in Health/Socios en Salud Sucursal Peru, Lima, Peru
| | - Karen Tintaya
- 7 Partners in Health/Socios en Salud Sucursal Peru, Lima, Peru
| | - Charles A Peloquin
- 8 College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, Florida; and
| | - Elna Osso
- 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Dylan B Tierney
- 9 Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kwonjune J Seung
- 9 Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,10 Partners in Health, Boston, Massachusetts
| | - Leonid Lecca
- 2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,7 Partners in Health/Socios en Salud Sucursal Peru, Lima, Peru
| | - Geraint R Davies
- 3 Institute of Infection and Global Health and.,4 Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Carole D Mitnick
- 9 Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,2 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,10 Partners in Health, Boston, Massachusetts
| |
Collapse
|