Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies.
Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies.
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DOI：
10.1186/s40249-016-0214-x
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发表时间：
2017-01-17
影响因子：
8.1
通讯作者：
Biadgilign S
中科院分区：
文献类型：
--
作者：
Kibret KT;Moges Y;Memiah P;Biadgilign S
抗结核药物耐药性是一个重大的公共卫生问题，威胁着全世界结核病护理和控制方面取得的进展。耐多药结核病（MDR-TB）的治疗成功率是一个不容忽视的关键问题。缺乏证据来评估关于耐多药结核病治疗的研究，这些研究侧重于直接观察治疗，短期（DOTS）-Plus计划的有效性。因此，评估和总结近年来DOTS-Plus计划中MDR-TB患者的总体治疗结果至关重要。因此，本研究的目的是评估和总结DOTS-Plus下耐多药结核病治疗结果的现有证据。对已发表文献进行了系统综述和荟萃分析。使用数据库MEDLINE®/PubMed®、Hinari和Google Scholar识别原始研究。使用Cochran's Q检验和I2统计量评估研究间的异质性。使用随机效应模型计算治疗结果的合并估计值。基于纳入荟萃分析的14项观察性研究，确定有5047例患者报告了治疗结局。其中，合并患病率为63.5%，（95% CI：58.4-68.5%）成功完成全部治疗（治愈或治疗完成），合并治愈率为55.6%，而12.6%（95% CI：9.0-16.2%）的患者死亡，14.2%（95% CI：11.6-16.8%）的患者退出治疗，7.6%（95% CI：5.6-9.7%）的患者治疗失败。总体而言，35.4%（95% CI：30-40.8%）的患者治疗结局不成功。在入组标准化治疗方案的患者中，观察到43%（95% CI：32-54%）的不成功治疗结局百分比不令人满意。这项研究显示，与世界卫生组织2015年至少75%至90%的目标相比，耐多药结核病患者的治疗成功率非常低。通过进行本文献综述观察到的高违约率可能解释了耐多药结核菌株在不同人群中的传播。个体化治疗方案的患者治疗成功率高于标准化治疗方案。建议进行进一步的基于个体的荟萃分析，以确定使用大规模和多中心研究的默认治疗的潜在因素。本文的在线版本（doi：10.1186/s40249-016-0214-x）包含补充材料，可供授权用户使用。
Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide. Treatment success rates of multidrug-resistant tuberculosis (MDR-TB) is a key issue that cannot be ignored. There is a paucity of evidence that assessed studies on the treatment of MDR-TB, which focus on the effectiveness of the directly observed treatment, short-course (DOTS)-Plus program. Therefore, it is crucial to assess and summarize the overall treatment outcomes for MDR-TB patients enrolled in the DOTS-Plus program in recent years. The purpose of this study was to thus assess and summarize the available evidence for MDR-TB treatment outcomes under DOTS-Plus. A systematic review and meta-analysis of published literature was conducted. Original studies were identified using the databases MEDLINE®/PubMed®, Hinari, and Google Scholar. Heterogeneity across studies was assessed using the Cochran’s Q test and I2 statistic. Pooled estimates of treatment outcomes were computed using the random effect model. Based on the 14 observational studies included in the meta-analysis, it was determined that 5 047 patients reported treatment outcomes. Of these, the pooled prevalence, 63.5% (95% CI: 58.4–68.5%) successfully completed full treatment (cured or treatment completed) with a pooled cure rate of 55.6%, whereas 12.6% (95% CI: 9.0–16.2%) of the patients died, 14.2% (95% CI: 11.6–16.8%) defaulted from therapy, and 7.6% (95% CI: 5.6–9.7%) failed therapy. Overall 35.4% (95% CI: 30–40.8%) of patients had unsuccessful treatment outcomes. An unsatisfactorily high percentage 43% (95% CI: 32–54%) of unsuccessful treatment outcomes was observed among patients who were enrolled in standardized treatment regimens. This study revealed that patients with MDR-TB exhibited a very low treatment success rate compared to the World Health Organization 2015 target of at least 75 to 90%. The high default rate observed by conducting this literature review could possibly explain the spread of the MDR-TB strain in various populations. A better treatment success rate was observed among patients in individualized treatment regimens than in standardized ones. Conducting further individual-based meta-analysis is recommended to identify potential factors for defaulting treatment using large-scale and multi-center studies. The online version of this article (doi:10.1186/s40249-016-0214-x) contains supplementary material, which is available to authorized users.