Treatment outcomes and risk factors for an unsuccessful outcome among patients with highly drug-resistant tuberculosis in Ukraine

OBJECTIVES

To describe demographics, clinical features, and treatment outcomes of patients with highly drug-resistant tuberculosis (TB) in Ukraine, and to evaluate risk factors for an unsuccessful outcome.

METHODS

Data from patients with multi-, pre-extensively, or extensively drug-resistant TB were collected prospectively from TB dispensaries in 15 out of 24 Ukrainian oblasts (regions) from 2020 to 2021. Treatment outcomes were evaluated using WHO definitions. Risk factors for an unsuccessful outcome were identified using a multivariable logistic regression model.

RESULTS

Among 1748 patients, the overall proportion of successful outcomes was 58% (95% confidence interval [95% CI] 56-60) (n = 1015/1748), ranging from 65% (95% CI: 62-69) (n = 531/814) for multidrug-resistant TB to 54% (95% CI: 49-58) (n = 301/563) for pre-extensively drug-resistant TB and 49% (95% CI: 44-55) (n = 183/371) for extensively drug-resistant TB. Results were similar across oblasts, with few exceptions. The strongest risk factors for an unsuccessful outcome were extensively drug-resistant TB (adjusted OR [aOR] 3.23; 95% CI: 1.88-5.53), total serum protein below 62 g/L in adults and below 57 g/L for children and adolescents (aOR 2.79; 95% CI: 1.93-4.04), psychiatric illness (aOR 2.79; 95% CI: 1.46-5.33), age at TB diagnosis >65 years (aOR 2.50; 95% CI: 1.42-4.42), and alcohol misuse (aOR 2.48; 95% CI: 1.89-3.26).

DISCUSSION

The overall proportion of successful outcomes among Ukrainians treated for highly drug-resistant TB was 58%, notably better compared with previous years, but still low for extensively drug-resistant TB. Risk factors for unsuccessful outcomes highlight that addressing socioeconomic factors in TB management is crucial. Efforts in maintaining TB dispensaries during and following the ongoing war are highly warranted.

Long-term safety and efficacy of tezepelumab in people with severe, uncontrolled asthma (DESTINATION): a randomised, placebo-controlled extension study

BACKGROUND

Tezepelumab is a human monoclonal antibody that blocks thymic stromal lymphopoietin. The drug has been tested previously in the phase 3 NAVIGATOR (NCT03347279) and SOURCE (NCT03406078) studies, and was subsequently approved as a treatment for severe asthma. This extension study recruited from NAVIGATOR and SOURCE and aimed to evaluate the long-term safety and efficacy of tezepelumab in individuals with severe, uncontrolled asthma.

METHODS

DESTINATION was a phase 3, multicentre, randomised, double-blind, placebo-controlled, long-term extension study. The study was done across 182 sites (including hospitals, clinics, medical centres, clinical trial centres, and private practices) in 18 countries. Participants (aged 12-80 years) were required to have good treatment compliance in the parent study. Randomisation was stratified by the parent study and all participants were re-randomised. Those who were previously randomised to receive tezepelumab in either parent study continued treatment of subcutaneous tezepelumab (210 mg every 4 weeks); those who were previously randomised to receive placebo in either parent study were re-randomised 1:1 to receive either subcutaneous tezepelumab (210 mg every 4 weeks) or placebo (every 4 weeks) using a randomisation list prepared by a computerised system. Total treatment duration (including the parent studies) was 104 weeks for all groups. Participants, investigators, and site staff were masked to treatment assignment. The primary endpoints were exposure-adjusted incidence of adverse events and serious adverse events and the secondary endpoint was the annualised asthma exacerbation rate; these were assessed from week 0 of the parent studies to week 104 of DESTINATION in all participants who were randomised and who received at least one dose of tezepelumab or placebo in either of the parent studies. The trial is registered with ClinicalTrials.gov, NCT03706079, and is closed to new participants.

FINDINGS

Participants were recruited between Jan 7, 2019, and Oct 15, 2020. For individuals who initially received tezepelumab (n=528) in NAVIGATOR, incidence of adverse events over 104 weeks was 49·62 (95% CI 45·16 to 54·39) per 100 patient-years, compared with 62·66 (56·93 to 68·81) for those receiving placebo (n=531; difference -13·04, 95% CI -17·83 to -8·18). For serious adverse events, incidence was 7·85 (6·14 to 9·89) per 100 patient-years for individuals who initially received tezepelumab and 12·45 (9·97 to 15·35) for those who received placebo (difference -4·59, -7·69 to -1·65). In SOURCE, incidence of adverse events was 47·15 (36·06 to 60·56) per 100 patient-years for those who initially received tezepelumab (n=74) and 69·97 (54·54 to 88·40) for those who received placebo (n=76; difference -22·82, -34·77 to -10·01). For serious adverse events, incidence was 13·14 (7·65 to 21·04) per 100 patient-years for those who initially received tezepelumab and 17·99 (10·66 to 28·44) for those who received placebo (difference -4·85, -14·88 to 4·53). Tezepelumab reduced the annualised asthma exacerbation rate over 104 weeks compared with placebo. In participants initially from NAVIGATOR, the annualised asthma exacerbation rate ratio over 104 weeks was 0·42 (95% CI 0·35 to 0·51); in those initially from SOURCE, the ratio over 104 weeks was 0·61 (0·38 to 0·96).

INTERPRETATION

Tezepelumab treatment was well tolerated for up to 2 years and resulted in sustained, clinically meaningful reductions in asthma exacerbations in individuals with severe, uncontrolled asthma. These findings are consistent with previous randomised, placebo-controlled studies and show the long-term safety and sustained efficacy of tezepelumab in individuals with severe, uncontrolled asthma.

FUNDING

AstraZeneca and Amgen.

PREVALENCE OF SENSORY DYSFUNCTIONS IN ADULT UKRAINIAN POPULATION WITH LABORATORY CONFIRMED COVID-19

OBJECTIVE

The aim: To analyse the structure of sensory impairments, associated with COVID-19. To identify terms of recovery periods depending on severity of disease, age and gender of the patients.

PATIENTS AND METHODS

Materials and methods: Within two weeks, 2225 patients with confirmed COVID-19 completed a questionnaire, created by Google Forms. General complaints, peculiarities of sensory impairments and recovery time were specified. After exclusion criteria application, data of 2108 patients were analyzed by R Statistics Package, Student's t-test, Wilcoxon rank-sum test, Fisher's exact test, Spearman's rank test.

RESULTS

Results: Among patients enrolled (973 males and 1135 females, mean age 28.6±0.18) the most frequent were olfactory (91.32%) and gustatory (66.03%) dysfunctions. Olfactory manifestations were usually accompanied by gustatory disorders (73.72%). Average duration of olfactory dysfunction was 15.46±0.45 days, gustatory - 11.3±0.33, hearing - 4.3±0.16, and visual - 6.53±0.23 days. It was found a correlation between duration of olfactory and gustatory impairments (r=0.65; p < 0.001), hearing and visual disorders (r=0.49; p < 0.05).

CONCLUSION

Conclusions: Olfactory and gustatory disorders are prevalent symptoms in Ukrainian population. 7.87% of respondents who had impairment of all four sensory functions had the longest recovery time. Duration of sensory impairments did not depend on age, type of treatment and severity of disease, which rises the question about the neurogenic pathway of virus.

Diagnostic Value of Leptin in Chronic Obstructive Pulmonary Disease of the Iii Degree in Patients with Excessive Body Weight

Chronic obstructive pulmonary disease (COPD) still remains a serious problem for the public health care system, since it commonly causes disability and mortality among the working population. Frequent combination of COPD with concomitant diseases is a key factor in predicting COPD consequences. Recently, the number of patients with a combination of COPD and overweight is on the increase, which is considered as a mutual aggravating factor and negatively affects the prognosis of the disease in such patients. The objective of this study was to investigate the diagnostic value of leptin in progression of COPD (III degree of bronchial obstruction in patients with overweight) course by studying its level in blood serum. Materials and methods: There were examined 112 patients with chronic obstructive pulmonary disease (COPD GOLD III) in different phases of pathological process. The pulmonary function (PF) test was performed by means of “SPIROKOM” device (Ukraine). The degree of overweight was determined by calculating the body mass index (BMI) using the formula І = m/h² (m – body mass in kilograms, h – height, in square meters (kg/m²). The level of leptin of systemic inflammatory markers was determined by a solid phase enzyme-linked immunosorbent assay in blood serum: “DRG Leptin Elisa” (Germany). Results and conclusions: The study revealed that overweight leads to a more severe course of COPD (III degree of bronchial obstruction), and the determination of leptin may serve as a diagnostic criterion in the progression of this pathology.

3,4-methylenedioxymethamphetamine (MDMA) impairs the extinction and reconsolidation of fear memory in rats

Clinical trials have demonstrated that 3,4-methylenedioxymethamphetamine (MDMA) paired with psychotherapy is more effective at reducing symptoms of post-traumatic stress disorder (PTSD) than psychotherapy or pharmacotherapy, alone or in combination. The processes through which MDMA acts to enhance psychotherapy are not well understood. Given that fear memories contribute to PTSD symptomology, MDMA could augment psychotherapy by targeting fear memories. The current studies investigated the effects of a single administration of MDMA on extinction and reconsolidation of cued and contextual fear memory in adult, male Long-Evans rats. Rats were exposed to contextual or auditory fear conditioning followed by systemic administration of saline or varying doses of MDMA (between 1 and 10 mg/kg) either 30 min before fear extinction training or immediately after brief fear memory retrieval (i.e. during the reconsolidation phase). MDMA administered prior to fear extinction training failed to enhance fear extinction memory, and in fact impaired drug-free cued fear extinction recall without impacting later fear relapse. MDMA administered during the reconsolidation phase, but not outside of the reconsolidation phase, produced a delayed and persistent reduction in conditioned fear. These findings are consistent with a general memory-disrupting effect of MDMA and suggest that MDMA could augment psychotherapy by modifying fear memories during reconsolidation without necessarily enhancing their extinction.

Influence of Glucosaminilemuramylpentapeptide on the Functional Peculiarities of the Respiratory System and the Dynamics of IL-6 in Patients with Infiltrative Tuberculosis Combined with Chronic Bronchitis

The aim of our study was to evaluate the functional peculiarities of the respiratory system and the dynamics of IL-6 in patients with infiltrative tuberculosis combined with chronic bronchitis.Materials and methods. There were examined 40 patients with infiltrative tuberculosis combined with chronic bronchitis: 18 patients receiving basic therapy according to the category and 22 patients who were added glucosaminilemuramylpentapeptide to basic therapy. Determination of IL-6 in bronchoalveolar content was performed by ELISA analysis.Results. The additional inclusion of glucosaminilemuramylpentapeptide into the complex therapy of patients with infiltrative tuberculosis combined with chronic bronchitis in acute phase manifests itself with positively aimed dynamic changes of the bronchial mucous membrane according to the data of endoscopy. The standard scheme of treatment combined with immune modulator affects the recovery of lung function in comorbidity of pathologies explaining it as the action of the means aimed at enhancing of sanogenetic mechanisms of liquidation of combination of specific and nonspecific inflammation in the broncho-pulmonary system, and thus – the reduction of the basis for secondary bronchial obstruction. The results of this study indicate the advisability of administration of immune modulator of muramylpeptide series.

Acute exercise enhances the consolidation of fear extinction memory and reduces conditioned fear relapse in a sex-dependent manner

Fear extinction-based exposure therapy is the most common behavioral therapy for anxiety and trauma-related disorders, but fear extinction memories are labile and fear tends to return even after successful extinction. The relapse of fear contributes to the poor long-term efficacy of exposure therapy. A single session of voluntary exercise can enhance the acquisition and consolidation of fear extinction in male rats, but the effects of exercise on relapse of fear after extinction are not well understood. Here, we characterized the effects of 2 h of voluntary exercise during the consolidation phase of contextual or auditory fear extinction learning on long-term fear extinction memory and renewal in adult, male and female, Long-Evans rats. Results indicate that exercise enhances consolidation of fear extinction memory and reduces fear relapse after extinction in a sex-dependent manner. These data suggest that brief bouts of exercise could be used as an augmentation strategy for exposure therapy, even in previously sedentary subjects. Fear memories of discrete cues, rather than of contextual ones, may be most susceptible to exercise-augmented extinction, especially in males. Additionally, exercise seems to have the biggest impact on fear relapse phenomena, even if fear extinction memories themselves are only minimally enhanced.