Madzgharashvili Tea, Salindri Argita D, Magee Matthew J, Tukvadze Nestani, Avaliani Zaza, Blumberg Henry M, Kempker Russell R, Lomtadze Nino
National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
Department of Population Health Sciences, Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA.
J Pediatric Infect Dis Soc. 2021 Apr 30;10(4):457-467. doi: 10.1093/jpids/piaa139.
Among pediatric patients with multidrug-resistant tuberculosis (MDR-TB), limited data exist regarding treatment outcomes in the context of the new and repurposed second-line TB drugs (SLDs). We aimed to describe the treatment outcomes among pediatric MDR-TB patients receiving new and repurposed SLDs including the proportion who achieved favorable outcomes.
We conducted a retrospective cohort study among pediatric patients (age ≤18 years) treated for MDR-TB in the country of Georgia from 2009 to 2016. A "new and repurposed" SLD regimen was defined as a regimen that included linezolid, bedaquiline, and/or delamanid. Favorable treatment outcome was defined by treatment completion or documented microbial "cure" status at the end of treatment. We assessed the association between the use of the new and repurposed SLDs with MDR-TB treatment outcomes using bivariate analyses and log-binomial regression.
There were 124 pediatric MDR-TB patients (median age: 13.7; interquartile range: 4.6-16.0) initiating treatment; 119 (96.0%) had a treatment outcome recorded and were included in our analyses. Eighteen (15.1%) patients received new and repurposed SLDs from 2015 or later. After adjusting for potential confounders, the proportion achieving favorable MDR-TB treatment outcomes was higher among patients treated with SLD regimens that included new and/or repurposed drugs when compared with those treated without (adjusted risk ratio: 1.17; 95% confidence interval: 0.51-2.72).
We observed a high proportion of favorable treatment outcomes among pediatric patients with MDR-TB receiving the new and repurposed SLDs. Further studies to evaluate the efficacy and children's tolerability of the new and repurposed SLDs are still warranted.
在患有耐多药结核病（MDR-TB）的儿科患者中，关于新的和重新利用的二线抗结核药物（SLDs）治疗效果的数据有限。我们旨在描述接受新的和重新利用的SLDs的儿科耐多药结核病患者的治疗效果，包括实现良好治疗效果的患者比例。
我们对2009年至2016年在格鲁吉亚国接受耐多药结核病治疗的儿科患者（年龄≤18岁）进行了一项回顾性队列研究。“新的和重新利用的”SLD方案被定义为包括利奈唑胺、贝达喹啉和/或地拉曼的方案。良好的治疗效果定义为治疗完成或治疗结束时记录的微生物“治愈”状态。我们使用双变量分析和对数二项回归评估新的和重新利用的SLDs的使用与耐多药结核病治疗效果之间的关联。
有124名儿科耐多药结核病患者（中位年龄：13.7；四分位间距：4.6-16.0）开始治疗；119名（96.0%）有记录的治疗效果并纳入我们的分析。18名（15.1%）患者在2015年或之后接受了新的和重新利用的SLDs。在调整潜在混杂因素后，与未接受新的和/或重新利用药物治疗的患者相比，接受包括新的和/或重新利用药物的SLD方案治疗的患者中，实现耐多药结核病良好治疗效果的比例更高（调整风险比：1.17；95%置信区间：0.51-2.72）。
我们观察到接受新的和重新利用的SLDs的儿科耐多药结核病患者中，有很高比例的患者获得了良好的治疗效果。仍有必要进行进一步研究以评估新的和重新利用的SLDs的疗效和儿童耐受性。
