Surgery as an Adjunctive Treatment for Multidrug-Resistant Tuberculosis: An Individual Patient Data Metaanalysis

Fox, Gregory J.; Mitnick, Carole D.; Benedetti, Andrea; Chan, Edward D.; Becerra, Mercedes C.; Chiang, Chifa; Keshavjee, Salmaan; Koh, Won‐Jung; Shiraishi, Yuji; Viiklepp, Piret; Yim, Jae Joon; Pasvol, Geoffrey; Robert, Jérôme; Shim, Tae Sun; Shin, Sonya; Menzies, Dick; Ahuja, Shama D.; Ashkin, David; Avendano, Monika; Banerjee, Rita; Bauer, Melissa; Burgos, Marcos; Centis, Rosella; Cobelens, Frank; Cox, Helen; D’Ambrosio, Lia; Lange, Wiel C M de; DeRiemer, Kathryn; Enarson, Donald A.; Falzon, Dennis; Flanagan, Katie L.; Flood, Jennifer; Gandhi, Neel R.; García-García, Lourdes; Granich, Reuben; Hollm-Delgado, Maria Graciela; Holtz, Timothy H.; Hopewell, Philip C.; Iseman, Michael D.; Jarlsberg, Leah G.; Kim, H R; Lancaster, Joey; Lange, Christoph; Leimane, Vaira; Leung, Chi‐Chiu; Li, J; Migliori, G. B.; Narita, Michiko; Nathanson, Eva; Odendaal, Ronel; O'Riordan, Philly; Pai, Madhukar; Palmero, Domingo; Park, S K; Peña, José M.; Pérez-Guzmán, Carlos; Ponce-de-León, Alfredo; Quelapio, M. I. D.; Quy, Hoang Thi; Riekstiņa, Vija; Royce, Sarah; Salim, Misbah; Schaaf, H. Simon; Seung, Kwonjune J.; Shah, Lena; Shean, Karen; Sifuentes–Osornio, José; Sotgiu, Giovanni; Strand, Matthew; Sung, Sook Whan; Tabarsi, Payam; Tupasi, Thelma E.; Vargas, Mario H.; Altena, R van; Walt, Martie van der; Werf, Tjip S van der; Westenhouse, Janice; Yew, Wing Wai

doi:10.1093/cid/ciw002

Cited by 68 publications

(56 citation statements)

References 12 publications

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“…Evidence for the effectiveness of different forms of elective pulmonary surgery in MDR-TB patients was derived from an IPD meta-analysis of 26 cohorts, as well as a systematic review and study-level meta-analysis [47, 48]. Two sets of analyses were undertaken: for partial pulmonary resection and for radical pneumonectomy.…”

Section: Resultsmentioning

confidence: 99%

World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update

et al. 2017

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Antimicrobial resistance is a major global concern. Tuberculosis (TB) strains resistant to rifampicin and other TB medicines challenge patient survival and public health. The World Health Organization (WHO) has published treatment guidelines for drug-resistant TB since 1997 and last updated them in 2016 based on reviews of aggregated and individual patient data from published and unpublished studies. An international expert panel formulated recommendations following the GRADE approach. The new WHO guidelines recommend a standardised 9–12 months shorter treatment regimen as first choice in patients with multidrug- or rifampicin-resistant TB (MDR/RR-TB) strains not resistant to fluoroquinolones or second-line injectable agents; resistance to these two classes of core second-line medicines is rapidly detectable with molecular diagnostics also approved by WHO in 2016. The composition of longer regimens for patients ineligible for the shorter regimen was modified. A first-ever meta-analysis of individual paediatric patient data allowed treatment recommendations for childhood MDR/RR-TB to be made. Delamanid is now also recommended in patients aged 6–17 years. Partial lung resection is a recommended option in MDR/RR-TB care. The 2016 revision highlighted the continued shortage of high-quality evidence and implementation research, and reiterated the need for clinical trials and best-practice studies to improve MDR/RR-TB patient treatment outcomes and strengthen policy.

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Section: Resultsmentioning

confidence: 99%

World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update

et al. 2017

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“…Positron emission tomography–computed tomography (PET‐CT) scans can help to identify patients at risk for relapse although the interpretation of metabolically active infiltrations is still difficult . Although the level of evidence was reported as being low, certain patients with localized infiltrations may benefit from surgical interventions after culture conversion . Carefully selected patients may also improve their immune system's capability to control the bacteria by host‐directed therapeutic interventions .…”

Section: Individualized Therapy Versus Standardized Treatment Regimenmentioning

confidence: 99%

“…112 Although the level of evidence was reported as being low, certain patients with localized infiltrations may benefit from surgical interventions after culture conversion. 113,114 Carefully selected patients may also improve their immune system's capability to control the bacteria by host-directed therapeutic interventions. 115 As an example for a host-aimed intervention, vitamin D supplementation has not led to significant improvement of treatment outcomes except for certain subgroups of patients with specific genetic polymorphisms.…”

Section: Individualized Therapy Versus Standardized Treatment Regimenmentioning

confidence: 99%

Drug‐resistant tuberculosis: An update on disease burden, diagnosis and treatment

et al. 2018

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The emergence of antimicrobial resistance against Mycobacterium tuberculosis, the leading cause of mortality due to a single microbial pathogen worldwide, represents a growing threat to public health and economic growth. The global burden of multidrug-resistant tuberculosis (MDR-TB) has recently increased by an annual rate of more than 20%. According to the World Health Organization approximately only half of all patients treated for MDR-TB achieved a successful outcome. For many years, patients with drug-resistant tuberculosis (TB) have received standardized treatment regimens, thereby accelerating the development of MDR-TB through drug-specific resistance amplification. Comprehensive drug susceptibility testing (phenotypic and/or genotypic) is necessary to inform physicians about the best drugs to treat individual patients with tailor-made treatment regimens. Phenotypic drug resistance can now often, but with variable sensitivity, be predicted by molecular drug susceptibility testing based on whole genome sequencing, which in the future could become an affordable method for the guidance of treatment decisions, especially in high-burden/resource-limited settings. More recently, MDR-TB treatment outcomes have dramatically improved with the use of bedaquiline-based regimens. Ongoing clinical trials with novel and repurposed drugs will potentially further improve cure-rates, and may substantially decrease the duration of MDR-TB treatment necessary to achieve relapse-free cure.

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“…A recent meta-analysis showed that partial lung resections were associated with better treatment outcomes for MDR-TB compared with no surgical procedure. 10 The timing of the surgical procedure is another point that is still unclear. The WHO currently recommends that resection surgery for MDR-TB should be timed to allow the best chances of cure with the least morbidity.…”

Section: Discussionmentioning

confidence: 99%

Surgical interventions for pulmonary tuberculosis in Mumbai, India: surgical outcomes and programmatic challenges

Shirodkar

Anande

Dalal³

et al. 2016

public health action

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Surgery as an Adjunctive Treatment for Multidrug-Resistant Tuberculosis: An Individual Patient Data Metaanalysis

Cited by 68 publications

References 12 publications

World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update

World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update

Drug‐resistant tuberculosis: An update on disease burden, diagnosis and treatment

Surgical interventions for pulmonary tuberculosis in Mumbai, India: surgical outcomes and programmatic challenges

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