Marks Suzanne M, Mase Sundari R, Morris Sapna Bamrah
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention,Atlanta, Georgia.
Clin Infect Dis. 2017 Jun 15;64(12):1670-1677. doi: 10.1093/cid/cix208.
BACKGROUND.: Evidence-based recommendations for treating persons having presumed latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) tuberculosis (TB) are lacking because published data consist of small observational studies. Tuberculosis incidence in persons treated for latent MDR -TB infection is unknown.
METHODS.: We conducted a systematic review of studies published 1 January 1994-31 December 2014 to analyze TB incidence, treatment completion and discontinuation, and cost-effectiveness. We considered contacts with LTBI effectively treated if they were on ≥1 medication to which their MDR-TB strain was likely susceptible. We selected studies that compared treatment vs nontreatment outcomes and performed a meta-analysis to estimate the relative risk of TB incidence and its 95% confidence interval.
RESULTS.: We abstracted data from 21 articles that met inclusion criteria. Six articles presented outcomes for contacts who were treated compared with those not treated for MDR-LTBI; 10 presented outcomes only for treated contacts, and 5 presented outcomes only for untreated contacts. The estimated MDR-TB incidence reduction was 90% (9%-99%) using data from 5 comparison studies. We also found high treatment discontinuation rates due to adverse effects in persons taking pyrazinamide-containing regimens. Cost-effectiveness was greatest using a fluoroquinolone/ethambutol combination regimen.
CONCLUSIONS.: Few studies met inclusion criteria, therefore results should be cautiously interpreted. We found a reduced risk of TB incidence with treatment for MDR-LTBI, suggesting effectiveness in prevention of progression to MDR-TB, and confirmed cost-effectiveness. However, we found that pyrazinamide-containing MDR-LTBI regimens often resulted in treatment discontinuation due to adverse effects.
由于已发表的数据均为小型观察性研究，因此缺乏针对接触传染性耐多药结核病（MDR-TB）后疑似潜伏性结核病（LTBI）患者的循证治疗建议。接受潜伏性MDR-TB感染治疗的患者的结核病发病率尚不清楚。
我们对1994年1月1日至2014年12月31日发表的研究进行了系统评价，以分析结核病发病率、治疗完成情况和停药情况以及成本效益。如果接触LTBI的患者服用了≥1种其MDR-TB菌株可能敏感的药物，我们认为其得到了有效治疗。我们选择了比较治疗与未治疗结果的研究，并进行了荟萃分析以估计结核病发病率的相对风险及其95%置信区间。
我们从21篇符合纳入标准的文章中提取了数据。6篇文章呈现了接受MDR-LTBI治疗的接触者与未接受治疗的接触者的结果；10篇仅呈现了接受治疗的接触者的结果，5篇仅呈现了未接受治疗的接触者的结果。使用5项比较研究的数据估计，MDR-TB发病率降低了90%（9%-99%）。我们还发现，服用含吡嗪酰胺方案的患者因不良反应导致的停药率很高。使用氟喹诺酮/乙胺丁醇联合方案的成本效益最高。
很少有研究符合纳入标准，因此对结果的解释应谨慎。我们发现，治疗MDR-LTBI可降低结核病发病率，这表明在预防进展为MDR-TB方面有效，并证实了成本效益。然而，我们发现含吡嗪酰胺的MDR-LTBI方案常常因不良反应导致治疗中断。
