Treatment outcomes among patients with extensively drug-resistant tuberculosis: systematic review and meta-analysis.
Treatment outcomes among patients with extensively drug-resistant tuberculosis: systematic review and meta-analysis.
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DOI：
10.1086/653115
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发表时间：
2010-07-01
期刊：
影响因子：
--
通讯作者：
Murray MB
中科院分区：
文献类型：
--
作者：
Jacobson KR;Tierney DB;Jeon CY;Mitnick CD;Murray MB
广泛耐药结核病（XDR TB）的治疗是一项重大挑战。二线抗分枝杆菌药物比一线药物更有效，毒性更大，成本更高，根据定义，XDR TB菌株对最有效的二线选择具有耐药性：注射剂和氟喹诺酮类药物。我们进行了一项荟萃分析，以评估XDR TB的治疗结果，并确定与良好反应相关的治疗方法。我们检索了PubMed和EMBASE数据库，以确定截至2009年5月进行的报告XDR TB治疗结局的研究。检索得到13项观察性研究，涵盖560例患者，其中43.7%（95%置信区间，32.8%-54.5%）的患者结局良好，定义为治愈或治疗完成，20.8%（95%置信区间，14.2%-27.3%）的患者死亡。随机效应荟萃分析和荟萃回归显示，接受新一代氟喹诺酮类药物治疗的患者比例较高的研究报告了较高比例的良好治疗结局（P = .012）。这项荟萃分析提供了第一个经验证据，即使用新一代氟喹诺酮类药物治疗XDR TB可显著改善治疗结局，即使药敏试验显示对代表性氟喹诺酮类药物具有耐药性。这些结果表明，在XDR TB方案中添加新一代氟喹诺酮类药物可能会改善治疗结果，应在精心设计的临床研究中进行系统评价。
The treatment of extensively drug-resistant tuberculosis (XDR TB) presents a major challenge. Second-line antimycobacterial drugs are less effective, more toxic, and more costly than first-line agents, and XDR TB strains are, by definition, resistant to the most potent second-line options: the injectable agents and fluoroquinolones. We conducted a meta-analysis to assess XDR TB treatment outcomes and to identify therapeutic approaches associated with favorable responses. We searched PubMed and EMBASE databases to identify studies conducted through May 2009 that report XDR TB treatment outcomes. The search yielded 13 observational studies covering 560 patients, of whom 43.7% (95% confidence interval, 32.8%–54.5%) experienced favorable outcomes, defined as either cure or treatment completion, and 20.8% (95% confidence interval, 14.2%–27.3%) died. Random effects meta-analysis and meta-regression showed that studies in which a higher proportion of patients received a later-generation fluoroquinolone reported a higher proportion of favorable treatment outcomes (P = .012). This meta-analysis provides the first empirical evidence that the use of later-generation fluoroquinolones for the treatment of XDR TB significantly improves treatment outcomes, even though drug-susceptibility testing demonstrates resistance to a representative fluoroquinolone. These results suggest that the addition of later-generation fluoroquinolones to XDR TB regimens may improve treatment outcomes and should be systematically evaluated in well-designed clinical studies.
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