Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes : an individual patient data meta-analysis of 9,153 patients

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dc.contributor.authorAhuja, Shama D.en_ZA
dc.contributor.authorAshkin, Daviden_ZA
dc.contributor.authorAvendano, Monikaen_ZA
dc.contributor.authorBanerjee, Ritaen_ZA
dc.contributor.authorBauer, Melissaen_ZA
dc.contributor.authorBayona, Jamie N.en_ZA
dc.contributor.authorBecerra, Mercedes C.en_ZA
dc.contributor.authorBenedetti, Andreaen_ZA
dc.contributor.authorBurgos, Marcosen_ZA
dc.contributor.authorCentis, Rosellaen_ZA
dc.contributor.authorChan, Eward D.en_ZA
dc.contributor.authorChiang, Chen-Yuanen_ZA
dc.contributor.authorCox, Helenen_ZA
dc.contributor.authorD'Ambrosio, Liaen_ZA
dc.contributor.authorDeRiemer, Kathyen_ZA
dc.contributor.authorDung, Nguyen Huyen_ZA
dc.contributor.authorEnarson, Donalden_ZA
dc.contributor.authorFalzon, Dennisen_ZA
dc.contributor.authorFlanagan, Katherineen_ZA
dc.contributor.authorFlood, Jenniferen_ZA
dc.contributor.authorGarcia-Garcia, Maria L.en_ZA
dc.contributor.authorGhandi, Neelen_ZA
dc.contributor.authorGranich, Reuben M.en_ZA
dc.contributor.authorHollm-Delgado, Maria G.en_ZA
dc.contributor.authorHoltz, Timothy H.en_ZA
dc.contributor.authorIseman, Michael D.en_ZA
dc.contributor.authorJarlsberg, Leah G.en_ZA
dc.contributor.authorKeshavjee, Salmaanen_ZA
dc.contributor.authorKim, Hye-Ryounen_ZA
dc.contributor.authorKoh, Won-Jungen_ZA
dc.contributor.authorLancaster, Joeyen_ZA
dc.contributor.authorLange,Christopheen_ZA
dc.contributor.authorLange, Wiel C. M. deen_ZA
dc.contributor.authorLeimane, Vairaen_ZA
dc.contributor.authorLeung, Chi Chiuen_ZA
dc.contributor.authorLi, Jiehuien_ZA
dc.contributor.authorMenzies, Dicken_ZA
dc.contributor.authorMigliori, Giovanni B.en_ZA
dc.contributor.authorMishustin, Sergey P.en_ZA
dc.contributor.authorMitnick, Carole D.en_ZA
dc.contributor.authorNarita, Masaen_ZA
dc.contributor.authorO'Riordan, Phillyen_ZA
dc.contributor.authorPai, Madhukaren_ZA
dc.contributor.authorPalmero, Domingoen_ZA
dc.contributor.authorPark, Seung-kyuen_ZA
dc.contributor.authorPasvol, Geoffreyen_ZA
dc.contributor.authorPena, Joseen_ZA
dc.contributor.authorPerez-Guzman, Carlosen_ZA
dc.contributor.authorQuelapio, Maria I. D.en_ZA
dc.contributor.authorPonce-De-Leon, Alfredoen_ZA
dc.contributor.authorRiekstina, Vijaen_ZA
dc.contributor.authorRobert, Jeromeen_ZA
dc.contributor.authorRoyce, Sarahen_ZA
dc.contributor.authorSchaaf, H. Simonen_ZA
dc.contributor.authorSeung, Kwonjune J.en_ZA
dc.contributor.authorShah, Lenaen_ZA
dc.contributor.authorShim, Tae Sunen_ZA
dc.contributor.authorShin, Sonya S.en_ZA
dc.contributor.authorShiraishi, Yujien_ZA
dc.contributor.authorSifuentes-Osornio, Joseen_ZA
dc.contributor.authorSotgiu, Giovannien_ZA
dc.contributor.authorStrand, Matthew J.en_ZA
dc.contributor.authorTabarsi, Payamen_ZA
dc.contributor.authorTupasi, Thelma E.en_ZA
dc.contributor.authorAltena, Robert vanen_ZA
dc.contributor.authorVan der Walt, Martieen_ZA
dc.contributor.authorWerf, Tjip S. van deren_ZA
dc.contributor.authorVargas, Mario H.en_ZA
dc.contributor.authorViiklepp, Piretten_ZA
dc.contributor.authorWestenhouse, Janiceen_ZA
dc.contributor.authorYew, Wing Waien_ZA
dc.contributor.authorYim, Jae-Joonen_ZA
dc.date.accessioned2013-02-08T10:12:48Z
dc.date.available2013-02-08T10:12:48Z
dc.date.issued2012-08-28
dc.descriptionCITATION: Ahuja, S. D., et al. 2012. Mutlidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes : an individual patient data meta-analysis of 9,153 patients. PLoS Medicine, 9(8): 1-16, doi: 10.1371/journal.pmed.1001300.
dc.descriptionThe original publication is available at http://journals.plos.org/plosmedicine
dc.description.abstractBackground: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. Methods and Findings: Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1–6.0]), ofloxacin (aOR: 2.5 [1.6–3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3–2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3–3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7–4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7–4.3]), ofloxacin (aOR: 2.3 [1.3–3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4–2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9–3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4–6.0]). Conclusions: In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment.en_ZA
dc.description.versionPublisher's versionen_ZA
dc.format.extent16 pages ; illustrations
dc.identifier.citationAhuja, S. D., et al. 2012. Mutlidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes : an individual patient data meta-analysis of 9,153 patients. PLoS Medicine, 9(8): 1-16, doi: 10.1371/journal.pmed.1001300en_ZA
dc.identifier.issn1549-1676 (online)
dc.identifier.issn1549-1277 (print)
dc.identifier.otherdoi: 10.1371/journal.pmed.1001300
dc.identifier.urihttp://hdl.handle.net/10019.1/79325
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectMultidrug-resistant tuberculosis -- Treatmenten_ZA
dc.subjectPatient Outcomesen_ZA
dc.subjectMeta-analysisen_ZA
dc.titleMultidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes : an individual patient data meta-analysis of 9,153 patientsen_ZA
dc.typeArticleen_ZA
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