Recurrent pulmonary tuberculosis after treatment success: a population-based retrospective study in China

Ruan, Qingwei; Yang, Qin; Sun, Feng; Shen, Yaojie; Wu, Jing; Jiang, Ning; Zhou, Jingyu; Shao, Lingyun; Zhang, Wenhong

doi:10.1016/j.cmi.2021.09.022

Cited by 15 publications

(17 citation statements)

References 21 publications

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“…Moreover, a previous study demonstrated that smear positivity after 2 months of treatment for the intensive phase was independently associated with recurrent PTB ( 2 ). Nearly 30% of patients were still smear positive at the end of the intensive phase ( 7 ).…”

Section: Discussionmentioning

confidence: 98%

“…Recurrent PTB remains a problem in successfully treated patients with sputum smear-positive PTB ( 2 ). This study reported a recurrence rate of 1.5% with the modified regimen after the 56-month follow-up, which was much lower than that with the standard regimen.…”

Section: Discussionmentioning

confidence: 99%

“…Tuberculosis (TB) is the second leading infectious killer after Coronavirus disease 2019 globally and also a major contributor to antimicrobial resistance; the incidence of retreatment pulmonary tuberculosis (PTB) cases was about 392,000 in 2019 ( 1 ). In China, Ruan et al ( 2 ) reported that 4.9% of 9,828 people in a retrospective study subsequently developed recurrent TB, and 9.6% were infected with M. tuberculosis isolates resistant at least to isoniazid and rifampicin. The first national survey of drug-resistant tuberculosis in China showed that 25.6% of patients with retreated TB had multi-drug resistant (MDR) infections ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

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Effect of a modified regimen on drug-sensitive retreated pulmonary tuberculosis: A multicenter study in China

Ge¹,

Ma²,

Zhang³

et al. 2023

Front. Public Health

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Background and objectiveRetreatment pulmonary tuberculosis (PTB) still accounts for a large proportion of tuberculosis, and the treatment outcome is unfavorable. The recurrence of retreatment PTB based on long-term follow-up has not been well demonstrated. This study aimed to evaluate effect of a modified regimen on drug-sensitive retreated pulmonary tuberculosis.MethodsThis multicenter cohort study was conducted in 29 hospitals from 23 regions of China from July 1, 2009, to December 31, 2020. Patients were divided into two treatment regimen groups including experimental group [modified regimen (4H-Rt2-E-Z-S(Lfx)/4H-Rt2-E)]and control group [standard regimen (2H-R-E-Z-S/6H-R-E or 3H-R-E-Z/6H-R-E)]. The patients enrolled were followed up of 56 months after successful treatment. We compared the treatment success rate, treatment failure rate, adverse reaction rate, and recurrence rate between two regimens. Multivariate Cox regression model was used to identify the potential risk factors for recurrence after successful treatment with proportional hazards assumptions tested for all variables.ResultsA total of 381 patients with retreatment PTB were enrolled, including 244 (64.0%) in the experimental group and 137 (36.0%) in the control group. Overall, the treatment success rate was significant higher in the experimental group than control group (84.0 vs. 74.5%, P = 0.024); no difference was observed in adverse reactions between the two groups (25.8 vs. 21.2%, P > 0.05). A total of 307 patients completed the 56 months of follow-up, including 205 with the modified regimen and 102 with the standard regimen. Among these, 10 cases (3.3%) relapsed, including 3 in the experimental group and 7 in the control group (1.5% vs 6.9%, P = 0.035). Reduced risks of recurrence were observed in patients treated with the modified regimen compared with the standard regimen, and the adjusted hazard ratio was 0.19 (0.04–0.77).ConclusionThe modified retreatment regimen had more favorable treatment effects, including higher treatment success rate and lower recurrence rate in patients with retreated drug-sensitive PTB.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of a modified regimen on drug-sensitive retreated pulmonary tuberculosis: A multicenter study in China

Ge¹,

Ma²,

Zhang³

et al. 2023

Front. Public Health

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“…In addition, the results of the subgroup analyses showed that the benefits of rhuIL-2 on sputum TB elimination was mainly driven by studies of patients with MDR-TB and recurrent TB, and the favorable influence of rhuIL-2 on some radiographic change may also be more remarkable in patients with MDR-TB and recurrent TB, such as the closure of pulmonary cavities. These findings highlight an important role of adjunctive rhuIL-2 for patients with MDR-TB and recurrent TB, which is clinically important because anti-TB treatment in these patients is more challenging [ 52 , 53 ]. The mechanisms are not fully determined.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Adjunctive Recombinant Human Interleukin-2 for Patients with Pulmonary Tuberculosis: A Meta-Analysis

Sheng

Weng

et al. 2022

Journal of Tropical Medicine

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Background. The results of previous clinical trials evaluating the efficacy and safety of recombinant human interleukin-2 (rhuIL-2) for adult patients with pulmonary tuberculosis showed inconsistent results. Accordingly, a comprehensive systematic review and meta-analysis was performed. Methods. Relevant randomized controlled trials (RCTs) were retrieved by searching the PubMed, Embase, Cochrane’s Library, Web of Science, Wanfang, and CNKI databases. A random-effects model was used to combine the results. Results. 18 RCTs with 2630 patients were included in this meta-analysis. Pooled results showed that adjunctive rhuIL-2 significantly increased the odds of sputum culture conversion to negative (risk ratio [RR]: 1.27, 95% CI: 1.09 to 1.47, p = 0.002 , I2 = 80%), sputum smear conversion to negative (RR: 1.35, 95% CI: 1.17 to 1.57, p < 0.001 , I2 = 83%), radiographic focus absorption (RR: 1.17, 95% CI: 1.06 to 1.30, p = 0.002 , I2 = 72), and cavity closure (RR: 1.24, 95% CI: 1.09 to 1.40, p < 0.001 , I2 = 23). The use of rhuIL-2 was not related to any severe adverse events which led to discontinuation of the treatment. Results showed that rhuIL-2 was related to an increased risk of fever (RR: 2.46, 95% CI: 1.29 to 4.70, p = 0.006 , I2 = 0%). The incidence of other adverse events, such as musculoskeletal pain, hepatic injury, and renal toxicity, was not significantly different between groups ( p all >0.05). Conclusions. rhuIL-2 is an effective adjunctive immunotherapy for patients with pulmonary tuberculosis.

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“…The traditional methods demonstrate some limitations in determining whether patients with TB are cured, as well as in identifying TB from latent tuberculosis infection. About 85% of TB patients can be successfully treated with a standardized 6-month anti-TB treatment regimen (2-month intensive phase plus a 4-month continuation phase) ( 2 ). However, due to the lack of a rapid and accurate method to evaluate the anti-TB efficacy, ~14% of discharged patients are not completely cured ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Untargeted metabolomics of pulmonary tuberculosis patient serum reveals potential prognostic markers of both latent infection and outcome

Wang¹,

Zeng

et al. 2022

Front. Public Health

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Currently, there are no particularly effective biomarkers to distinguish between latent tuberculosis infection (LTBI) and active pulmonary tuberculosis (PTB) and evaluate the outcome of TB treatment. In this study, we have characterized the changes in the serum metabolic profiles caused by Mycobacterium tuberculosis (Mtb) infection and standard anti-TB treatment with isoniazid–rifampin–pyrazinamide–ethambutol (HRZE) using GC-MS and LC-MS/MS. Seven metabolites, including 3-oxopalmitic acid, akeboside ste, sulfolithocholic acid, 2-decylfuran (4,8,8-trimethyldecahydro-1,4-methanoazulen-9-yl)methanol, d-(+)-camphor, and 2-methylaminoadenosine, were identified to have significantly higher levels in LTBI and untreated PTB patients (T0) than those in uninfected healthy controls (Un). Among them, akeboside Ste and sulfolithocholic acid were significantly decreased in PTB patients with 2-month HRZE (T2) and cured PTB patients with 2-month HRZE followed by 4-month isoniazid-rifampin (HR) (T6). Receiver operator characteristic curve analysis revealed that the combined diagnostic model showed excellent performance for distinguishing LT from T0 and Un. By analyzing the biochemical and disease-related pathways, we observed that the differential metabolites in the serum of LTBI or TB patients, compared to healthy controls, were mainly involved in glutathione metabolism, ascorbate and aldarate metabolism, and porphyrin and chlorophyll metabolism. The metabolites with significant differences between the T0 group and the T6 group were mainly enriched in niacin and nicotinamide metabolism. Our study provided more detailed experimental data for developing laboratory standards for evaluating LTBI and cured PTB.

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Recurrent pulmonary tuberculosis after treatment success: a population-based retrospective study in China

Cited by 15 publications

References 21 publications

Effect of a modified regimen on drug-sensitive retreated pulmonary tuberculosis: A multicenter study in China

Effect of a modified regimen on drug-sensitive retreated pulmonary tuberculosis: A multicenter study in China

Efficacy and Safety of Adjunctive Recombinant Human Interleukin-2 for Patients with Pulmonary Tuberculosis: A Meta-Analysis

Untargeted metabolomics of pulmonary tuberculosis patient serum reveals potential prognostic markers of both latent infection and outcome

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