Orenstein Evan W, Basu Sanjay, Shah N Sarita, Andrews Jason R, Friedland Gerald H, Moll Anthony P, Gandhi Neel R, Galvani Alison P
Tugela Ferry Care and Research Collaboration, Tugela Ferry, KwaZulu-Natal, South Africa.
Lancet Infect Dis. 2009 Mar;9(3):153-61. doi: 10.1016/S1473-3099(09)70041-6.
Multidrug-resistant (MDR) tuberculosis is a growing clinical and public-health concern. To evaluate existing evidence regarding treatment regimens for MDR tuberculosis, we used a Bayesian random-effects meta-analysis of the available therapeutic studies to assess how the reported proportion of patients treated successfully is influenced by differences in treatment regimen design, study methodology, and patient population. Successful treatment outcome was defined as cure or treatment completion. 34 clinical reports with a mean of 250 patients per report met the inclusion criteria. Our analysis shows that the proportion of patients treated successfully improved when treatment duration was at least 18 months, and if patients received directly observed therapy throughout treatment. Studies that combined both factors had significantly higher pooled success proportions (69%, 95% credible interval [CI] 64-73%) than other studies of treatment outcomes (58%, 95% CI 52-64%). Individualised treatment regimens had higher treatment success (64%, 95% CI 59-68%) than standardised regimens (54%, 95% CI 43-68%), although the difference was not significant. Treatment approaches and study methodologies were heterogeneous across studies. Many important variables, including patients' HIV status, were inconsistently reported between studies. These results underscore the importance of strong patient support and treatment follow-up systems to develop successful MDR tuberculosis treatment programmes.
耐多药结核病是一个日益严重的临床和公共卫生问题。为了评估关于耐多药结核病治疗方案的现有证据，我们对可用的治疗研究进行了贝叶斯随机效应荟萃分析，以评估报告的成功治疗患者比例如何受到治疗方案设计、研究方法和患者群体差异的影响。成功的治疗结果定义为治愈或完成治疗。34份临床报告符合纳入标准，每份报告平均有250名患者。我们的分析表明，当治疗持续时间至少为18个月，且患者在整个治疗过程中接受直接观察治疗时，成功治疗的患者比例会提高。结合这两个因素的研究的合并成功比例（69%，95%可信区间[CI]64 - 73%）显著高于其他治疗结果研究（58%，95%CI 52 - 64%）。个体化治疗方案的治疗成功率（64%，95%CI 59 - 68%）高于标准化方案（54%，95%CI 43 - 68%），尽管差异不显著。各研究的治疗方法和研究方法存在异质性。许多重要变量，包括患者的艾滋病毒感染状况，在各研究之间的报告不一致。这些结果强调了强大的患者支持和治疗随访系统对于制定成功的耐多药结核病治疗方案的重要性。
