Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-analysis.
Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-analysis.
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DOI：
10.1001/jamanetworkopen.2022.16527
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发表时间：
2022-06-01
影响因子：
13.8
通讯作者：
Clements, Archie C. A.
中科院分区：
文献类型：
--
作者：
Alene, Kefyalew Addis;Murray, Megan B.;van de Water, Brittney J.;Becerra, Mercedes C.;Atalell, Kendalem Asmare;Nicol, Mark P.;Clements, Archie C. A.
耐多药结核病（MDR-TB）孕妇的治疗结果和不良事件是什么？在对10项研究（包括275名MDR-TB妊娠患者）进行的系统综述和荟萃分析中，治疗成功的汇总比例为72.5%，良好妊娠结局的汇总比例为73.2%。不良事件，如肝功能损害、肾功能损害、听力损失和低钾血症，在妊娠耐多药结核病患者中很常见，发生在一半以上的患者中。这项研究表明，当怀孕的耐多药结核患者接受有效的治疗方案时，可以获得高的治疗成功率和良好的妊娠结局。妊娠期耐多药结核病（MDR-TB）的管理具有挑战性，但没有系统的综合证据可以准确衡量治疗结果。系统总结妊娠耐多药结核病患者的治疗结果和不良事件。检索了PubMed、Scopus、Web of Science和ProQuest，检索时间从每个数据库成立之初到2021年8月31日。包含具有确定治疗结局的妊娠患者队列的研究合格。独立评审员筛选研究并评估偏倚风险。本研究遵循系统性综述和荟萃分析报告指南的首选报告项目。采用随机效应模型进行荟萃分析。异质性的来源进行了探讨，通过元回归。主要结局是每种治疗结局（包括治疗成功、死亡、失访和治疗失败）的患者比例，次要结局包括妊娠期间发生不良事件的患者比例。在这项系统性综述和荟萃分析中，纳入了10项研究，其中包含275例具有治疗结局可用数据的妊娠患者。治疗成功的汇总估计值为72.5%（95% CI，63.3%-81.0%），死亡为6.8%（95% CI，2.6%-12.4%），失访为18.4%（95% CI，13.1%-24.2%），治疗失败为0.6%（95% CI，0.0%-2.9%）。与使用利奈唑胺的患者比例低于中位值的研究相比，使用利奈唑胺的患者比例高于中位值的研究（20.1%）的治疗成功率显著更高（比值比，1.22; 95% CI，1.05-1.42）。超过一半的孕妇（54.7%; 95% CI，43.5%-65.4%）发生至少1种类型的不良事件，最常见的是肝功能损害（30.4%; 95% CI，17.7%-45.7%），肾功能损害（14.9%; 95% CI，6.2%-28.3%），低钾血症（11.9%; 95% CI，3.9%-25.6%），听力损失（11.8%; 95%CI，5.5%-21.3%），胃肠道疾病（11.8%; 95% CI，5.2%-21.8%）、精神疾病（9.1%; 95% CI，2.5%-21.6%）或贫血（8.9%; 95% CI，3.6%-17.4%）。有利妊娠结局的汇总比例为73.2%（95% CI，49.4%-92.1%）。最常见的不良妊娠结局类型为早产（9.5%; 95% CI，0.0%-29.0%）、妊娠丢失（6.0%; 95% CI，1.3%-12.9%）、低出生体重（3.9%; 95% CI，0.0%-18.7%）和死产（1.9%; 95% CI，0.1%-5.1%）。大多数研究的评分为低质量（3项研究）或中等质量（4项研究）。在这项系统性综述和荟萃分析中，报告了耐多药结核妊娠患者的高治疗成功率和良好的妊娠结局。需要进一步研究为妊娠耐多药结核病患者设计更短、更有效和更安全的治疗方案。本系统综述和荟萃分析研究了妊娠耐多药结核病（MDR-TB）患者的治疗结局和不良事件。
What are the treatment outcomes and adverse events among pregnant patients with multidrug-resistant tuberculosis (MDR-TB)? In a systematic review and meta-analysis of 10 studies including 275 pregnant patients with MDR-TB, the pooled proportion of treatment success was 72.5%, and the pooled proportion of favorable pregnancy outcomes was 73.2%. Adverse events, such as liver function impairment, kidney function impairment, hearing loss, and hypokalemia, were common among pregnant patients with MDR-TB, occurring in more than half of the patients. This study suggests that a high rate of treatment success and favorable pregnancy outcomes can be achieved when pregnant patients with MDR-TB are treated with effective regimens. The management of multidrug-resistant tuberculosis (MDR-TB) during pregnancy is challenging, yet no systematic synthesis of evidence has accurately measured treatment outcomes. To systematically synthesize treatment outcomes and adverse events among pregnant patients with MDR-TB. PubMed, Scopus, Web of Science, and ProQuest were searched from the inception of each database through August 31, 2021. Studies containing cohorts of pregnant patients with a defined treatment outcome were eligible. Independent reviewers screened studies and assessed the risk of bias. The study followed the Preferring Reporting Items for Systematic Review and Meta-analyses reporting guideline. Meta-analysis was performed using random-effects models. The sources of heterogeneity were explored through metaregression. The primary outcome was the proportion of patients with each treatment outcome (including treatment success, death, loss to follow-up, and treatment failure), and the secondary outcomes included the proportion of patients experiencing adverse events during pregnancy. In this systematic review and meta-analysis, 10 studies containing 275 pregnant patients with available data on treatment outcomes were included. The pooled estimate was 72.5% (95% CI, 63.3%-81.0%) for treatment success, 6.8% (95% CI, 2.6%-12.4%) for death, 18.4% (95% CI, 13.1%-24.2%) for loss to follow-up, and 0.6% (95% CI, 0.0%-2.9%) for treatment failure. Treatment success was significantly higher in studies in which the proportion of patients taking linezolid was greater than the median (20.1%) compared with studies in which this proportion was lower than the median (odds ratio, 1.22; 95% CI, 1.05-1.42). More than half of the pregnant patients (54.7%; 95% CI, 43.5%-65.4%) experienced at least 1 type of adverse event, most commonly liver function impairment (30.4%; 95% CI, 17.7%-45.7%), kidney function impairment (14.9%; 95% CI, 6.2%-28.3%), hypokalemia (11.9%; 95% CI, 3.9%-25.6%), hearing loss (11.8%; 95% CI, 5.5%-21.3%), gastrointestinal disorders (11.8%; 95% CI, 5.2%-21.8%), psychiatric disorders (9.1%; 95% CI, 2.5%-21.6%), or anemia (8.9%; 95% CI, 3.6%-17.4%). The pooled proportion of favorable pregnancy outcomes was 73.2% (95% CI, 49.4%-92.1%). The most common types of adverse pregnancy outcomes were preterm birth (9.5%; 95% CI, 0.0%-29.0%), pregnancy loss (6.0%; 95% CI, 1.3%-12.9%), low birth weight (3.9%; 95% CI, 0.0%-18.7%), and stillbirth (1.9%; 95% CI, 0.1%-5.1%). Most of the studies had low-quality (3 studies) or medium-quality (4 studies) scores. In this systematic review and meta-analysis, high treatment success and favorable pregnancy outcomes were reported among pregnant patients with MDR-TB. Further research is needed to design shorter, more effective, and safer treatment regimens for pregnant patients with MDR-TB. This systematic review and meta-analysis examines treatment outcomes and adverse events among pregnant patients with multidrug-resistant tuberculosis (MDR-TB).
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DOI：
10.1093/cid/ciaa189
发表时间：
2021-04-08
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Loveday M;Hughes J;Sunkari B;Master I;Hlangu S;Reddy T;Chotoo S;Green N;Seddon JA
通讯作者：
Seddon JA
影响因子：
3.7
作者：
Ohene, Sally-Ann;Bakker, Mirjam I.;Klatser, Paul
通讯作者：
Klatser, Paul
影响因子：
76.2
作者：
Lan, Zhiyi;Ahmad, Nafees;Menzies, Dick
通讯作者：
Menzies, Dick
影响因子：
3.7
作者：
Johnston JC;Shahidi NC;Sadatsafavi M;Fitzgerald JM
通讯作者：
Fitzgerald JM
影响因子：
8.1
作者：
Kibret KT;Moges Y;Memiah P;Biadgilign S
通讯作者：
Biadgilign S