Factors influencing treatment efficacy in patients with multiple and extensive drug resistant tuberculosis

Lapshina, I. S.; Салихов, Б.У.; Мякишева, Т В; Kostromtsov, Stanislav; Paramonov, A. V.; Andreev, V.A.

doi:10.21292/2075-1230-2020-98-10-28-32

Tuberk. bolezni lëgk.

2020

DOI: 10.21292/2075-1230-2020-98-10-28-32

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Factors influencing treatment efficacy in patients with multiple and extensive drug resistant tuberculosis

I. S. Lapshina¹,

Б.У. Салихов²,

Т В Мякишева³

et al.

Abstract: The objective: to determine factors influencing treatment efficacy in patients with multiple (MDR) and extensive (XDR) drug resistant tuberculosis. Subjects and methods. The medical files of 107 tuberculosis patients (men – 75, women – 32) were analyzed, 17 of them were HIV positive. Those 107 patients were registered for treatment as per chemotherapy (CT) regimens IV-V in 2017 in Kaluga Region. 99 (92.5%) patients suffered from tuberculosis with lung tissue destruction. 60.7% (65 patients) had MDR, while 20.8… Show more

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Eﬃcacy of using bedaquiline in treatment of tuberculosis patients with multiple and extensive drug resistance

Старшинова

Назаренко

Belyaeva³

et al. 2022

Tuberk. bolezni lëgk.

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The objective: to compare treatment eﬃcacy of pulmonary tuberculosis patients with multiple (MDR) and extensive drug resistance (XDR) using a standard chemotherapy regimen and the regimen containing bedaquiline.Subjects and Methods. A retrospective study was conducted to analyze treatment outcomes in 219 patients with pulmonary tuberculosis and MDR/XDR of Mycobacterium tuberculosis (MTB) aged 18-75 years old who were treated in in-patient and out-patient facilities of St. Petersburg from 2016 to 2019. Treatment outcomes were analyzed by subgroups formed taking into account resistance patterns and addition of bedaquiline to the treatment regimens: Ia – n = 94 (MDR TB; Bq-) and IIa ‒ n = 80 (XDR TB; Bq-); Ib ‒ n = 22 (MDR TB; Bq+) and IIb ‒ n = 23 (XDR TB; Bq+). Clinical and laboratory parameters of patients, the severity of comorbidity were assessed before the start of treatment, after 3, 6, 12-14 and 18-24 months of therapy, as well as after therapy completion and during the follow-up period. Statistical analysis was carried out using Statistica 10.0 and methods of parametric and nonparametric statistics and the SPSS 16.0 software, where p ≤ 0.05 was considered signiﬁcant.Results. XDR TB patients in Subgroup IIb were signiﬁcantly more likely to have a high level of comorbidity according to Charlson index (from 5 to 6 points) – in 34.7% of cases versus 5.0% in Subgroup IIa. At all stages of treatment in MDR TB patients with Bq+ (Ib), sputum conversion was recorded signiﬁcantly more often versus patients of Subgroup Ia with Bq- when examined at all stages, with maximum eﬀectiveness achieved by 18-24 months of treatment (90.9%). Treatment eﬃcacy of XDR TB patients (IIb, Bq+) was also signiﬁcantly higher versus treatment regimen containing no bedaquiline (60.8% (IIb, Bq+) versus 25.0% (IIa, Bq-), χ2 = 4.61, p < 0.05).Conclusions. Achieved high eﬃcacy of therapy in Subgroups Ib and IIb containing Bq provided a positive impact on treatment default rates, that were recorded in a low percentage of cases in those subgroups. An ineﬀective course of treatment in MDR TB patients treated with regimens containing no Bq was observed in 42.5% in Subgroup Ia, while this rate made only 0.09% in Subgroup Ib. Treatment eﬀectiveness was the highest in XDR TB patients of Subgroup IIb when Bq was added to the treatment regimen.

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Eﬃcacy of using bedaquiline in treatment of tuberculosis patients with multiple and extensive drug resistance

Старшинова

Назаренко

Belyaeva³

et al. 2022

Tuberk. bolezni lëgk.

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Long-term results of treatment of patients with newly detected pulmonary tuberculosis

Pavlova,

Lushina,

Anisimova

et al. 2023

Medicinskij sovet

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Introduction. The article is devoted to the effectiveness of the treatment of pulmonary tuberculosis with multiple (MDR) and broad drug resistance (XDR) M. tuberculosis (MBT) in patients after the end of the main course of treatment (intensive and continuation phase), which were observed with clinical cure in 3rd dispensary registration group.Aim. To study the long-term results of treatment of newly diagnosed patients with pulmonary tuberculosis with MDR and XDR MBT with the determination of significant risk factors for relapse in a megalopolis.Materials and methods. The main course of treatment was completed by 119 newly diagnosed patients with pulmonary tuberculosis with MDR or XDR TB for the period from 2013 to 2019, who were treated in anti-tuberculosis hospitals in St. Petersburg and outpatient in St. Petersburg Interdistrict Petrograd-Primorsky TB Dispensary No. 3. The patients were divided into two groups: the main group (MG) consisted of 40 people who received treatment regimens that included drugs (thioureidoiminomethylpyridinium perchlorate (perchlosone, bedaquiline, linezolid ), the control group (CG) – 79 people who received who received standard therapy, without the above drugs. The groups are comparable in clinical, radiological and bacteriological characteristics. The course of treatment was found effective in 86 (72.3%): in MG – in 34 (85.0%) people, in CG – in 52 (65.8%) people, p < 0.01. These 86 patients were transferred to the 3rd group of dispensary registration with a diagnosis of “clinical cure”.Results. Adverse treatment outcomes were analyzed, including the causes of tuberculosis recurrence. The use of drugs (perchlosone, bedaquiline, linezolid) in the complex chemotherapy of tuberculosis with MDR and XDR MBT increases the effectiveness of treatment of patients and significantly less often they have a recurrence of pulmonary tuberculosis (12.5%), compared with the group without the use of these drugs (27.8%). The most significant risk factors for relapses of drug-resistant tuberculosis: the preservation of residual cavities in the absence of bacterial excretion at the end of the main c male gender, concomitant pathology (HIV infection), past incarceration, late detection of the disease and destructive forms of tuberculosis.Conclusions. The main course of therapy was found to be effective in 86 (72.3%) in patients with MG – in 34 (85.0%) people, in CG – in 52 (65.8%) people, p < 0.01. All the patients who completed the course of therapy were transferred to the 3rd group of dispensary registration with a diagnosis of “clinical cure”. Relapses of the disease occurred much less frequently in patients receiving perchlozon, bedaquiline, linezolid in complex therapy compared with the control group.

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Factors influencing treatment efficacy in patients with multiple and extensive drug resistant tuberculosis

Cited by 2 publications

References 2 publications

Eﬃcacy of using bedaquiline in treatment of tuberculosis patients with multiple and extensive drug resistance

Eﬃcacy of using bedaquiline in treatment of tuberculosis patients with multiple and extensive drug resistance

Long-term results of treatment of patients with newly detected pulmonary tuberculosis

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