Tuberculosis Platform, South African Medical Research Council, Pretoria, South Africa
Tuberculosis Platform, South African Medical Research Council, Pretoria, South Africa.
Antimicrob Agents Chemother. 2020 Dec 16;65(1). doi: 10.1128/AAC.00744-20.
Treatment outcomes among multidrug-resistant tuberculosis (MDR-TB) patients receiving ethambutol, cycloserine, or terizidone as part of a standardized regimen were compared, determining occurrence of serious adverse drug events (SADEs). Newly diagnosed adult MDR-TB patients were enrolled between 2000 and 2004, receiving a standardized multidrug regimen for 18 to 24 months, including ethambutol, cycloserine, or terizidone. Cycloserine and terizidone were recorded individually. SADEs and factors associated with culture conversion and unfavorable treatment outcomes (default, death, treatment failure) were determined. Of 858 patients, 435 (51%) received ethambutol, 278 (32%) received cycloserine, and 145 (17%) received terizidone. Demographic and baseline clinical data were comparable. Successful treatment occurred in 56%, significantly more in patients receiving cycloserine (60%) and terizidone (62%) than in those receiving ethambutol (52% [ = 0.03]). Defaults rates were 30% in ethambutol patients versus 15% and 11% for cycloserine and terizidone patients, respectively. Terizidone was associated with fewer unfavorable outcomes (adjusted odds ratio [AOR], 0.4; = 0.008; 95% confidence interval [CI], 0.2 to 0.8). Patients receiving cycloserine were more likely to achieve culture conversion than those receiving ethambutol or terizidone (AOR, 2.2; = 0.02; 95% CI, 1.12 to 4.38). Failure to convert increased the odds of unfavorable outcomes (AOR, 23.7; < 0.001; 95% CI, 13 to 44). SADEs were reported in two patients receiving ethambutol, seven patients receiving cycloserine, and three receiving terizidone ( = 0.05). Ethambutol was associated with high culture conversion and default rates. Cycloserine achieved higher culture conversion rates than terizidone. Fewer patients on terizidone experienced SADEs, with lower default rates. The differences that we observed between cycloserine and terizidone require further elucidation.
比较了接受乙胺丁醇、环丝氨酸或替利霉素作为标准化方案一部分的耐多药结核病（MDR-TB）患者的治疗结果，确定了严重药物不良反应（SADE）的发生情况。2000 年至 2004 年间新诊断的成年 MDR-TB 患者入组，接受标准化多药方案治疗 18-24 个月，包括乙胺丁醇、环丝氨酸或替利霉素。单独记录环丝氨酸和替利霉素。确定了 SADE 以及与培养转换和不良治疗结局（默认、死亡、治疗失败）相关的因素。在 858 名患者中，435 名（51%）接受乙胺丁醇，278 名（32%）接受环丝氨酸，145 名（17%）接受替利霉素。人口统计学和基线临床数据具有可比性。56%的患者治疗成功，接受环丝氨酸（60%）和替利霉素（62%）的患者显著高于接受乙胺丁醇（52%[=0.03]）的患者。乙胺丁醇患者的失访率为 30%，而环丝氨酸和替利霉素患者分别为 15%和 11%。替利霉素与较少的不良结局相关（调整后的优势比[OR]，0.4；=0.008；95%置信区间[CI]，0.2 至 0.8）。与接受乙胺丁醇或替利霉素的患者相比，接受环丝氨酸的患者更有可能实现培养转换（OR，2.2；=0.02；95%CI，1.12 至 4.38）。未能转换增加了不良结局的可能性（OR，23.7；<0.001；95%CI，13 至 44）。乙胺丁醇组有 2 例患者、环丝氨酸组有 7 例患者和替利霉素组有 3 例患者报告了 SADE（=0.05）。乙胺丁醇与高培养转化率和失访率相关。环丝氨酸的培养转化率高于替利霉素。接受替利霉素治疗的患者发生 SADE 的人数较少，失访率较低。我们在环丝氨酸和替利霉素之间观察到的差异需要进一步阐明。
