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Outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine African countries

BACKGROUND: Treatment outcomes of the shorter regimen for rifampicin-resistant tuberculosis are not completely established. We report on these outcomes two years after treatment completion among patients enrolled in an observational cohort study in nine African countries. METHODS: 1,006 patients tre...

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Autores principales: Schwœbel, Valérie, Trébucq, Arnaud, Kashongwe, Zacharie, Bakayoko, Alimata S., Kuaban, Christopher, Noeske, Juergen, Harouna, Souleymane H., Souleymane, Mahamadou B., Piubello, Alberto, Ciza, François, Fikouma, Valentin, Gasana, Michel, Ouedraogo, Martial, Gninafon, Martin, Van Deun, Armand, Tagliani, Elisa, Cirillo, Daniela M., Koura, Kobto G., Rieder, Hans L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152829/
https://www.ncbi.nlm.nih.gov/pubmed/32300732
http://dx.doi.org/10.1016/j.eclinm.2020.100268
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author Schwœbel, Valérie
Trébucq, Arnaud
Kashongwe, Zacharie
Bakayoko, Alimata S.
Kuaban, Christopher
Noeske, Juergen
Harouna, Souleymane H.
Souleymane, Mahamadou B.
Piubello, Alberto
Ciza, François
Fikouma, Valentin
Gasana, Michel
Ouedraogo, Martial
Gninafon, Martin
Van Deun, Armand
Tagliani, Elisa
Cirillo, Daniela M.
Koura, Kobto G.
Rieder, Hans L.
author_facet Schwœbel, Valérie
Trébucq, Arnaud
Kashongwe, Zacharie
Bakayoko, Alimata S.
Kuaban, Christopher
Noeske, Juergen
Harouna, Souleymane H.
Souleymane, Mahamadou B.
Piubello, Alberto
Ciza, François
Fikouma, Valentin
Gasana, Michel
Ouedraogo, Martial
Gninafon, Martin
Van Deun, Armand
Tagliani, Elisa
Cirillo, Daniela M.
Koura, Kobto G.
Rieder, Hans L.
author_sort Schwœbel, Valérie
collection PubMed
description BACKGROUND: Treatment outcomes of the shorter regimen for rifampicin-resistant tuberculosis are not completely established. We report on these outcomes two years after treatment completion among patients enrolled in an observational cohort study in nine African countries. METHODS: 1,006 patients treated with the nine-month regimen were followed every six months with sputum cultures up to 24 months after treatment completion. The risk of any unfavourable outcome, of failure and relapse, and of death during and after treatment was analysed according to patient's characteristics and initial drug susceptibility by Cox proportional hazard models. FINDINGS: Respectively 67.8% and 57.2% patients had >=1 culture result six months and 12 months after treatment completion. Fourteen relapses were diagnosed. The probability of relapse-free success was 79.3% (95% confidence interval [CI] 76.6–82.0%) overall, 80.9% (95% CI 78.0–84.0%) among HIV-negative and 72.5% (95% CI 66.5–78.9%) among HIV-infected patients. Initial fluoroquinolone (adjusted hazard ratio [aHR] 6.7 [95% CI 3.4–13.1]) and isoniazid resistance (aHR 9.4 [95% CI 1.3–68.0]) were significantly associated with increased risk of failure/relapse and of any unfavourable outcome. INTERPRETATION: The close to 80% relapse-free success indicates the good outcome of the regimen in low-and middle-income settings. Results confirm the lesser effectiveness of the regimen in patients with initial resistance to fluoroquinolones and support the use of high-dose isoniazid, but do not support exclusion of patients for resistance to drugs other than fluoroquinolones. FUNDING: Expertise-France and Agence Française de Développement.
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spelling pubmed-71528292020-04-16 Outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine African countries Schwœbel, Valérie Trébucq, Arnaud Kashongwe, Zacharie Bakayoko, Alimata S. Kuaban, Christopher Noeske, Juergen Harouna, Souleymane H. Souleymane, Mahamadou B. Piubello, Alberto Ciza, François Fikouma, Valentin Gasana, Michel Ouedraogo, Martial Gninafon, Martin Van Deun, Armand Tagliani, Elisa Cirillo, Daniela M. Koura, Kobto G. Rieder, Hans L. EClinicalMedicine Research paper BACKGROUND: Treatment outcomes of the shorter regimen for rifampicin-resistant tuberculosis are not completely established. We report on these outcomes two years after treatment completion among patients enrolled in an observational cohort study in nine African countries. METHODS: 1,006 patients treated with the nine-month regimen were followed every six months with sputum cultures up to 24 months after treatment completion. The risk of any unfavourable outcome, of failure and relapse, and of death during and after treatment was analysed according to patient's characteristics and initial drug susceptibility by Cox proportional hazard models. FINDINGS: Respectively 67.8% and 57.2% patients had >=1 culture result six months and 12 months after treatment completion. Fourteen relapses were diagnosed. The probability of relapse-free success was 79.3% (95% confidence interval [CI] 76.6–82.0%) overall, 80.9% (95% CI 78.0–84.0%) among HIV-negative and 72.5% (95% CI 66.5–78.9%) among HIV-infected patients. Initial fluoroquinolone (adjusted hazard ratio [aHR] 6.7 [95% CI 3.4–13.1]) and isoniazid resistance (aHR 9.4 [95% CI 1.3–68.0]) were significantly associated with increased risk of failure/relapse and of any unfavourable outcome. INTERPRETATION: The close to 80% relapse-free success indicates the good outcome of the regimen in low-and middle-income settings. Results confirm the lesser effectiveness of the regimen in patients with initial resistance to fluoroquinolones and support the use of high-dose isoniazid, but do not support exclusion of patients for resistance to drugs other than fluoroquinolones. FUNDING: Expertise-France and Agence Française de Développement. Elsevier 2020-02-10 /pmc/articles/PMC7152829/ /pubmed/32300732 http://dx.doi.org/10.1016/j.eclinm.2020.100268 Text en © 2020 Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research paper
Schwœbel, Valérie
Trébucq, Arnaud
Kashongwe, Zacharie
Bakayoko, Alimata S.
Kuaban, Christopher
Noeske, Juergen
Harouna, Souleymane H.
Souleymane, Mahamadou B.
Piubello, Alberto
Ciza, François
Fikouma, Valentin
Gasana, Michel
Ouedraogo, Martial
Gninafon, Martin
Van Deun, Armand
Tagliani, Elisa
Cirillo, Daniela M.
Koura, Kobto G.
Rieder, Hans L.
Outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine African countries
title Outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine African countries
title_full Outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine African countries
title_fullStr Outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine African countries
title_full_unstemmed Outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine African countries
title_short Outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine African countries
title_sort outcomes of a nine-month regimen for rifampicin-resistant tuberculosis up to 24 months after treatment completion in nine african countries
topic Research paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152829/
https://www.ncbi.nlm.nih.gov/pubmed/32300732
http://dx.doi.org/10.1016/j.eclinm.2020.100268
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