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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
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.
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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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