Changes in treatment for multidrug-resistant tuberculosis according to national income
- Nakwon Kwak1,
- Nicholas Winters2,
- Jonathon R. Campbell2,
- Edward D. Chan3,4,
- Medea Gegia5,
- Christoph Lange6,7,8,9,
- Myungsun Lee10,
- Vladimir Milanov11,
- Dick Menzies2 and
- Jae-Joon Yim1⇑
- 1Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
- 2Respiratory Epidemiology & Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre Research Institute, McGill University, Montreal, Quebec, Canada
- 3Department of Academic Affairs, National Jewish Health, Denver, Colorado, United States
- 4Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, United States
- 5Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
- 6Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- 7German Center for Infection Research, Clinical Tuberculosis Unit, Borstel, Germany
- 8Respiratory Medicine & International Health, University of Luebeck, Luebeck, Germany
- 9Department of Medicine, Karolinska Institute, Stockholm, Sweden
- 10International Tuberculosis Research Center, Seoul, South Korea
- 11Department of Pulmonary Diseases, Medical University – Sofia, Hospital of Respiratory Diseases “St. Sofia”, Sofia, Bulgaria
- Dr Jae-Joon Yim, M.D., Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea. E-mail: yimjj{at}snu.ac.kr
Abstract
This study was aimed to analyse temporal changes in treatments for and outcomes of multidrug-resistant/rifampin-resistant tuberculosis (MDR/RR-TB) in the context of national economic status.
We analysed data collected by the Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB Treatment on MDR/RR-TB patients from 37 countries. The data were stratified by three national income levels (low-/lower-middle, upper-middle, and high) and grouped by time of treatment initiation (2001–2003, 2004–2006, 2007–2009, 2010–2012, and 2013–2015). Temporal trends over the study period were analysed. The probability of treatment success in different income groups over time was calculated using generalised linear mixed models with random effects.
In total, 9036 patients were included in the analysis. Over the study period, use of Group A drugs (levofloxacin/moxifloxacin, bedaquiline, and linezolid) recommended by the World Health Organization increased and treatment outcomes improved in all income groups. Between 2001–2003 and 2013–2015, treatment success rates increased from 60% to 78% in low-/lower-middle-income countries, from 40% to 67% in upper-middle-income countries, and from 73% to 81% in high-income countries. In earlier years, the probability of treatment success in upper-middle-income countries was lower than that in low-/lower-middle-income countries, but no difference was observed after 2010. However, high-income countries had persistently higher probability of treatment success compared to upper-middle income countries.
Improved treatment outcomes and greater uptake of Group A drugs were observed over time for patients with MDR/RR-TB at all income levels. However, treatment outcomes are still unsatisfactory, especially in upper-middle-income countries.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Kwak has nothing to disclose.
Conflict of interest: Mr. Winters has nothing to disclose.
Conflict of interest: Dr. Campbell has nothing to disclose.
Conflict of interest: Dr. Chan has nothing to disclose.
Conflict of interest: Dr. Gegia has nothing to disclose.
Conflict of interest: Dr. Lange reports personal fees from Chiesi, personal fees from Gilead, personal fees from Janssen, personal fees from Lucane, personal fees from Novartis, personal fees from Oxoid, personal fees from Berlin Chemie, personal fees from Thermofisher, personal fees from Oxfordimmunotec, outside the submitted work.
Conflict of interest: Dr. Lee has nothing to disclose.
Conflict of interest: Dr. Milanov has nothing to disclose.
Conflict of interest: Dr. Menzies has nothing to disclose.
Conflict of interest: Dr. Yim reports and I received donations of linezolid (Zyvox) from Pfizer Inc. and Delamanid (Deltyba) from Otsuka Pharmaceutical Co. for the clinical trials which I serve(d) as a principal investigator.
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- Received April 25, 2020.
- Accepted June 2, 2020.
- Copyright ©ERS 2020