9-12 months short treatment for patients with MDR-TB increases treatment success in Kyrgyzstan

Abstract

Introduction: MDR/RR-TB is a growing problem in Kyrgyzstan. In 2005, the country introduced standard or individualized treatment for 20-24 months. Because of poor treatment outcomes, in 2017 a short treatment with strict eligibility criteria was introduced. The aim of this study was to compare characteristics and treatment outcomes of MDR/RR-TB patients receiving short (9-12 months) treatment in 2017 with those receiving standard or individualized (20-24 months) treatment in 2016/2017.
 Methodology: A comparative cohort study using routine programmatic data. Characteristics, sputum culture conversion and treatment outcomes were compared between those on short treatment with those on standard/individualized treatment using the chi-square test, crude and adjusted risk ratios (RR and aRR).
 Results: The study included 274, 82 and 132 patients on standard, individualized and short treatment, respectively. There were more females, fewer migrants/homeless and unemployed and more new TB patients on short treatment compared with the other two groups. A favorable outcome (cure and treatment completed) was significantly higher in short treatment patients (83%) compared with those on standard (50%) or individualized (59%) treatment (p < 0.001). There was higher 1-month sputum culture conversion with short treatment (35%) compared with the other two groups (19% and 24%, p < 0.05). Short treatment (aRR 1.6, 1.4-1.8), female gender (aRR 1.2, 1.1-1.4), not being homeless (aRR 12.9, 4.5-17.3) and having new TB (aRR 1.3, 1.0-1.5) were independently associated with a favorable outcome.
 Conclusions: The treatment success was higher in selected MDR-TB patients given short treatment in Kyrgyzstan: this regimen should be scaled-up to all MDR-TB patients.

Evaluation of a Modified Short all oral Treatment Regimen for Rifampicin-Multidrug Resistant Tuberculosis in Dominican Republic

“…Our results align with success rates (ranging from 75 to 90%) reported in other countries for RR/MDR-TB patients treated with all oral mSTR [18,19]. Importantly, the treatment success achieved with this simpli ed mSTR, utilizing Bdq, Lfx and Lzd as core drugs, and Cfz and Cs as companion drugs, appears to provide more favorable outcomes than those found in Central Asia.…”

“…Tuberculosis (TB), one of the most prevalent infectious diseases globally, continues to exert a signi cant burden on mortality and morbidity. In 2022 TB ranked as the second-largest infectious killer worldwide, surpassed only by coronavirus disease (COVID- 19). It was reported as the primary cause of death among people with the human immunode ciency virus (HIV) and a signi cant contributor to deaths related to antimicrobial resistance [1].…”

Comparative effectiveness of individualized longer and standardized shorter regimens in the treatment of multidrug resistant tuberculosis in a high burden country

“…This finding was in line with the previous studies conducted elsewhere. For example, a study from Kyrgyzstan has reported that there was higher 1-month SCC among patients treated with STR than those who were treated with LTR (Zhdanova et al, 2021). Likewise, an almost two-fold greater likelihood of SCC by 2 months following treatment of MDR-TB patients with STR has been reported from Uzbekistan (du Cros et al, 2017).…”

“…As fluoroquinolones (FQs) are considered the backbone of MDR-TB treatment, the presence Mfx in STR which is comparatively more potent and effective than Lfx (present in LTR) against both susceptible and resistant MTB strains (Maitre et al, 2017;Du et al, 2019) could be one of the potential causes of early SCC and better cure rate in patients treated with STR. The presence of strong bactericidal agents like CFZ, and high dose INH which can retain activity against INH resistance due to inhA or katG 315 mutations could be the other possible cause of superior anti-microbial activity by STR (Van Deun et al, 2018;Du et al, 2019;Zhdanova et al, 2021). In current study, the mortality rates in the STR (9.9%) and the LTR (18.3%) were in compliance with the elsewhere reported mortality ranges for MDR-TB patients treated with STR (5.6%-7.8%) (Aung et al, 2014;Kuaban et al, 2015;Khan et al, 2017;Trébucq et al, 2018) and LTR (9.5%-25%) (Ahmad et al, 2015;Rao et al, 2015;Javaid et al, 2017c;Khan et al, 2019;Khan, et al, 2022a).…”

Sputum smear conversion and treatment outcomes among drug-resistant pulmonary tuberculosis patients in eastern Ethiopia: A 9-years data analysis

“…Even though, the cost-effective directly observed therapy (DOT) strategy highly helps many world countries in controlling and preventing the disease; however, the prevalence of DR-TB has been increasing in the last 15 years, especially in poor economic countries due to a shortage of effective diagnostic and treatment access ( 8 , 10 ).…”