Value of observational data for multidrug-resistant tuberculosis

Rodriguez, Carly A; Mitnick, Carole D.; Franke, Molly F

doi:10.1016/s1473-3099(19)30424-4

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…The use of causal inference methods allowed us to correctly frame the question, as highlighted by Chani et al [49]: 'Among people presenting to the clinic with signs and symptoms; to what extent does the use of Xpert cause a reduction in 2-year mortality among patients with RR-TB?'. While the use of causal inference methodology has already found its way in HIV research [50][51][52], its application is novel in the field of TB and DR-TB [53][54][55][56].…”

Section: Discussionmentioning

confidence: 99%

Estimating the effect of a rifampicin resistant tuberculosis diagnosis by the Xpert MTB/RIF assay on two-year mortality

De Vos,

Westreich,

Scott

et al. 2023

PLOS Glob Public Health

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Studies assessing patient-centred outcomes of novel rifampicin resistant tuberculosis (RR-TB) diagnostics are rare and mostly apply conventional methods which may not adequately address biases. Even though the Xpert MTB/RIF molecular assay was endorsed a decade ago for simultaneous diagnosis of tuberculosis and RR-TB, the impact of the assay on mortality among people with RR-TB has not yet been assessed. We analysed data of an observational prospective cohort study (EXIT-RIF) performed in South Africa. We applied a causal inference approach using inverse odds of sampling weights to rectify survivor bias and selection bias caused by differing screening guidelines. We also adjusted for confounding using a marginal structural model with inverse probability of treatment weights. We estimated the total effect of an RR-TB diagnosis made by the Xpert assay versus the pre-Xpert diagnostic algorithm (entailing a targeted Line Probe Assay (LPA) among TB-confirmed patients) on two-year mortality and we assessed mediation by RR-treatment initiation. Of the 749 patients diagnosed with RR-TB [247 (33%) by the pre-Xpert diagnostic algorithm and 502 (67%) by the Xpert assay], 42.7% died. Of these, 364 (48.6%) patients died in the pre-Xpert group and 200 (39.8%) in the Xpert group. People diagnosed with RR-TB by the Xpert assay had a higher odds of RR-TB treatment initiation compared to those diagnosed by the targeted LPA-based diagnostic process (OR 2.79; 95%CI 2.19–3.56). Receiving an RR-TB diagnosis by Xpert resulted in a 28% reduction in the odds of mortality within 2 years after presentation to the clinic (ORCI 0.72; 95%CI 0.53–0.99). Causal mediation analysis suggests that the higher rate of RR-TB treatment initiation in people diagnosed by the Xpert assay explains the effect of Xpert on 2-year mortality [natural indirect effect odds ratio 0.90 (95%CI 0.85–0.96). By using causal inference methods in combination with high quality observational data, we could demonstrate that the introduction of the Xpert assay caused a 28% reduction in 2-year odds of mortality of RR-TB. This finding highlights the need for advocacy for a worldwide roll-out of rapid molecular tests. Because the effect is mainly caused by increased RR-TB treatment initiation, health care systems should also ensure timely initiation of effective treatment upon an RR-TB diagnosis.

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Section: Discussionmentioning

confidence: 99%

Estimating the effect of a rifampicin resistant tuberculosis diagnosis by the Xpert MTB/RIF assay on two-year mortality

De Vos,

Westreich,

Scott

et al. 2023

PLOS Glob Public Health

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“…Although RCTs remain indispensable to improve the quality of evidence, they may be difficult to employ in populations with complex conditions and rare phenotypes, such as those with drug-resistant TB. 93 Alternatively, observational research requires far less resources and can be conducted by clinicians using real-world, individual patient data, similar to those studies included in the aforementioned meta-analyses which informed guideline recommendations. 44,57 The WHO acknowledged the ability of observational research to facilitate the study of useful correlates of outcome, including the regimen composition.…”

Section: Addre Ss Ing the G Aps With Obs Ervational Re S E Archmentioning

confidence: 99%

“…As discussed previously, several gaps in knowledge still exist in areas where data and evidence are lacking, such as treatment duration and optimal dosing of anti‐TB agents. Although RCTs remain indispensable to improve the quality of evidence, they may be difficult to employ in populations with complex conditions and rare phenotypes, such as those with drug‐resistant TB 93 . Alternatively, observational research requires far less resources and can be conducted by clinicians using real‐world, individual patient data, similar to those studies included in the aforementioned meta‐analyses which informed guideline recommendations 44,57 .…”

Section: Addressing the Gaps With Observational Researchmentioning

confidence: 99%

Updates in pulmonary drug‐resistant tuberculosis pharmacotherapy: A focus on BPaL and BPaLM

Holger,

Althubyani,

Morrisette

et al. 2024

Pharmacotherapy

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Drug‐resistant tuberculosis (TB) is a major public health concern and contributes to high morbidity and mortality. New evidence supports the use of shorter duration, all‐oral regimens, which represent an encouraging treatment strategy for drug‐resistant TB. As a result, the landscape of drug‐resistant TB pharmacotherapy has drastically evolved regarding treatment principles and preferred agents. This narrative review focuses on the key updates of drug‐resistant TB treatment, including the use of short‐duration all‐oral regimens, while calling attention to current gaps in knowledge that may be addressed in future observational studies.

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“…Still, potential problems exist with use of observational data. The greatest are the potential for different forms of confounding and bias (18,19). This can be mitigated, at least partially, by careful adjustment for the many potential confounding factors, including age, prior treatment history, extent of drug resistance and disease, concurrent conditions, and treatment response (2).…”

Section: Online Reportmentioning

confidence: 99%

Improving Quality of Patient Data for Treatment of Multidrug- or Rifampin-Resistant Tuberculosis

Campbell¹,

Falzon²,

Mirzayev³

et al. 2020

Emerg. Infect. Dis.

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Value of observational data for multidrug-resistant tuberculosis

Cited by 5 publications

References 5 publications

Estimating the effect of a rifampicin resistant tuberculosis diagnosis by the Xpert MTB/RIF assay on two-year mortality

Estimating the effect of a rifampicin resistant tuberculosis diagnosis by the Xpert MTB/RIF assay on two-year mortality

Updates in pulmonary drug‐resistant tuberculosis pharmacotherapy: A focus on BPaL and BPaLM

Improving Quality of Patient Data for Treatment of Multidrug- or Rifampin-Resistant Tuberculosis

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