Dosing schedules of 6-month regimens and relapse for pulmonary tuberculosis
Dosing schedules of 6-month regimens and relapse for pulmonary tuberculosis
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DOI：
10.1164/rccm.200605-637oc
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发表时间：
2006-11-15
影响因子：
24.7
通讯作者：
Tam, Cheuk M.
中科院分区：
文献类型：
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作者：
Chang, Kwok C.;Leung, Chi C.;Tam, Cheuk M.
基本原理：减少结核病复发的最佳方法是open.Objectives：我们研究了减少复发的可能性，增加dosing schedule.Methods：我们进行了一项系统回顾发表的临床试验，涉及成人队列与肺结核治疗使用6-mo利福霉素含方案，这是根据7类排序的剂量计划。假设空化和阳性2个月培养是复发的驱动力，静态确定性模型将每个队列中观察到的复发和未复发的数量分为8个亚组。合并按空化、2个月培养和治疗方案分层的亚组，可以估计调整后的复发风险。χ（2）趋势检验和逻辑回归分析检验了复发和给药方案之间的关系。结果：我们在32个队列的5，208名患者中确定了200例细菌学复发。logistic风险模型显示，给药方案与复发之间存在显著的剂量-反应关系，（95%置信区间）：1.6（0.6-4.1）每日初始阶段（113）加每周三次持续阶段（CP），2.8（1.3-6.1）（每日IP+每周两次CP），2.8（1.4-5.7）（每周三次），5.0（2.4-10.5）（每日IP+每周一次利福喷丁），7.1（3.3-15.3）（每周三次IP+每周一次利福喷丁）。在空洞的存在下，只有6个月的每日或每日IP加每周三次CP达到最佳估计复发风险低于5%，他们达到6%时，2个月的文化也positive.Conclusions：空洞性结核病是最好的治疗方案，包括每日IP和每周三次CP，这可能会延长2个月的文化是积极的。
Rationale: The optimal approach for reducing tuberculosis relapse is open.Objectives: We examined the possibility of reducing relapse by increasing dosing schedules.Methods: We conducted a systematic review of published clinical trials involving adult cohorts with pulmonary tuberculosis treated using 6-mo rifamycin-containing regimens, which were grouped under seven categories ordered by dosing schedules. Assuming cavitation and positive 2-mo culture were the driving forces for relapse, a static deterministic model apportioned observed numbers with and without relapse in each cohort into eight subgroups. Combining subgroups stratified by cavitation, 2-mo culture, and regimens enabled estimation of adjusted relapse risks. chi(2) Tests for trend and logistic regression analysis examined the relationship between relapse and dosing schedules.Results: We identified 200 cases of bacteriologic relapse out of 5,208 patients in 32 cohorts. A logistic risk model showed a significant dose-response relationship between dosing schedules and relapse, with the following odds (95% confidence intervals) of relapse relative to daily regimens: 1.6 (0.6-4.1) for daily initial phase (113) plus thrice-weekly continuation phase (CP), 2.8 (1.3-6.1) for daily IP plus twice-weekly CP, 2.8 (1.4-5.7) for thrice-weekly, 5.0 (2.4-10.5) for daily IP plus once-weekly rifapentine, and 7.1 (3.3-15.3) for thrice-weekly IP plus once-weekly rifapentine. In the presence of cavitation, only 6-mo daily or daily IP plus thrice-weekly CP attained best-estimated relapse risks below 5%; they reached 6% when 2-mo culture was also positive.Conclusions: Cavitary tuberculosis is best treated with 6-mo regimens comprising daily IP and thrice-weekly CP, which may be extended when 2-mo culture is positive.