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Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment
OBJECTIVE: Studying treatment duration for rifampicin-resistant and multidrug-resistant tuberculosis (MDR/RR-TB) using observational data is methodologically challenging. We aim to present a hypothesis generating approach to identify factors associated with shorter duration of treatment. STUDY DESIG...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10553332/ https://www.ncbi.nlm.nih.gov/pubmed/37797071 http://dx.doi.org/10.1371/journal.pone.0292106 |
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author | Winters, Nicholas Schnitzer, Mireille E. Campbell, Jonathon R. Ripley, Susannah Winston, Carla Savic, Rada Ahmad, Nafees Bisson, Gregory Dheda, Keertan Esmail, Ali Gegia, Medea Monedero, Ignacio Dalcolmo, Margareth Pretti Rodrigues, Denise Singla, Rupak Yim, Jae-Joon Menzies, Dick |
author_facet | Winters, Nicholas Schnitzer, Mireille E. Campbell, Jonathon R. Ripley, Susannah Winston, Carla Savic, Rada Ahmad, Nafees Bisson, Gregory Dheda, Keertan Esmail, Ali Gegia, Medea Monedero, Ignacio Dalcolmo, Margareth Pretti Rodrigues, Denise Singla, Rupak Yim, Jae-Joon Menzies, Dick |
author_sort | Winters, Nicholas |
collection | PubMed |
description | OBJECTIVE: Studying treatment duration for rifampicin-resistant and multidrug-resistant tuberculosis (MDR/RR-TB) using observational data is methodologically challenging. We aim to present a hypothesis generating approach to identify factors associated with shorter duration of treatment. STUDY DESIGN AND SETTING: We conducted an individual patient data meta-analysis among MDR/RR-TB patients restricted to only those with successful treatment outcomes. Using multivariable linear regression, we estimated associations and their 95% confidence intervals (CI) between the outcome of individual deviation in treatment duration (in months) from the mean duration of their treatment site and patient characteristics, drug resistance, and treatments used. RESULTS: Overall, 6702 patients with successful treatment outcomes from 84 treatment sites were included. We found that factors commonly associated with poor treatment outcomes were also associated with longer treatment durations, relative to the site mean duration. Use of bedaquiline was associated with a 0.51 (95% CI: 0.15, 0.87) month decrease in duration of treatment, which was consistent across subgroups, while MDR/RR-TB with fluoroquinolone resistance was associated with 0.78 (95% CI: 0.36, 1.21) months increase. CONCLUSION: We describe a method to assess associations between clinical factors and treatment duration in observational studies of MDR/RR-TB patients, that may help identify patients who can benefit from shorter treatment. |
format | Online Article Text |
id | pubmed-10553332 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-105533322023-10-06 Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment Winters, Nicholas Schnitzer, Mireille E. Campbell, Jonathon R. Ripley, Susannah Winston, Carla Savic, Rada Ahmad, Nafees Bisson, Gregory Dheda, Keertan Esmail, Ali Gegia, Medea Monedero, Ignacio Dalcolmo, Margareth Pretti Rodrigues, Denise Singla, Rupak Yim, Jae-Joon Menzies, Dick PLoS One Research Article OBJECTIVE: Studying treatment duration for rifampicin-resistant and multidrug-resistant tuberculosis (MDR/RR-TB) using observational data is methodologically challenging. We aim to present a hypothesis generating approach to identify factors associated with shorter duration of treatment. STUDY DESIGN AND SETTING: We conducted an individual patient data meta-analysis among MDR/RR-TB patients restricted to only those with successful treatment outcomes. Using multivariable linear regression, we estimated associations and their 95% confidence intervals (CI) between the outcome of individual deviation in treatment duration (in months) from the mean duration of their treatment site and patient characteristics, drug resistance, and treatments used. RESULTS: Overall, 6702 patients with successful treatment outcomes from 84 treatment sites were included. We found that factors commonly associated with poor treatment outcomes were also associated with longer treatment durations, relative to the site mean duration. Use of bedaquiline was associated with a 0.51 (95% CI: 0.15, 0.87) month decrease in duration of treatment, which was consistent across subgroups, while MDR/RR-TB with fluoroquinolone resistance was associated with 0.78 (95% CI: 0.36, 1.21) months increase. CONCLUSION: We describe a method to assess associations between clinical factors and treatment duration in observational studies of MDR/RR-TB patients, that may help identify patients who can benefit from shorter treatment. Public Library of Science 2023-10-05 /pmc/articles/PMC10553332/ /pubmed/37797071 http://dx.doi.org/10.1371/journal.pone.0292106 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication. |
spellingShingle | Research Article Winters, Nicholas Schnitzer, Mireille E. Campbell, Jonathon R. Ripley, Susannah Winston, Carla Savic, Rada Ahmad, Nafees Bisson, Gregory Dheda, Keertan Esmail, Ali Gegia, Medea Monedero, Ignacio Dalcolmo, Margareth Pretti Rodrigues, Denise Singla, Rupak Yim, Jae-Joon Menzies, Dick Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment |
title | Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment |
title_full | Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment |
title_fullStr | Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment |
title_full_unstemmed | Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment |
title_short | Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment |
title_sort | identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10553332/ https://www.ncbi.nlm.nih.gov/pubmed/37797071 http://dx.doi.org/10.1371/journal.pone.0292106 |
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