Wang Ming-Gui, Liu Xiang-Min, Wu Shou-Quan, He Jian-Qing
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China.
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China; West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, PR China.
Microbes Infect. 2023 Jan-Feb;25(1-2):105020. doi: 10.1016/j.micinf.2022.105020. Epub 2022 Jul 3.
The purpose of this research was to evaluate the effect of clofazimine on drug-resistant tuberculosis treatment outcomes.
A systematic search was conducted in the PubMed, Web of Science and EMBASE databases to identify eligible studies published up to July 10, 2021. The search terms were as follows: "clofazimine," "tuberculosis," "multidrug resistant tuberculosis" or "extensively drug resistant tuberculosis" and their synonyms or similar words. Two researchers independently screened the titles, abstracts, and full texts for inclusion. Meta-analysis was performed with Stata version 16.0 (Stata Corp., College Station, Texas, USA). Risk ratios (RRs) with 95% CIs were calculated to evaluate the treatment outcome.
Eight studies including 3219 participants were included in the meta-analysis. The meta-analysis found that the rates of treatment completion was higher in patients receiving clofazimine-containing regimens than in those not receiving clofazimine-containing regimens (RR: 1.185 (1.060-1.325), P = 0.003). Significant reduction in treatment failure (RR: 0.598 (0.473-0.756), P < 0.001) was found in the clofazimine treatment group. The subgroup analyses of randomized controlled trials (RCTs) found a higher rates of favorable outcomes, treatment completion and cure in the clofazimine group than in the control group (RR: 1.203 (1.029-1.407), P = 0.020; RR: 3.167 (2.043-4.908), P < 0.001; and RR: 1.251 (1.031-1.518), P = 0.023, respectively). Patients receiving clofazimine had a lower risk of treatment failure than those not receiving clofazimine (RR: 0.529 (0.454-0.616), P < 0.001). However, clofazimine treatment did not have a statistically significant effect on all-cause mortality in RCTs.
This study demonstrated that compared with patients who do not receive clofazimine, this drug has the potential to achieve a higher favorable outcome, treatment completion and cure rates, and a lower treatment failure risk among drug-resistant tuberculosis cases.
本研究的目的是评估氯法齐明对耐多药结核病治疗结果的影响。
在PubMed、科学网和EMBASE数据库中进行系统检索，以识别截至2021年7月10日发表的符合条件的研究。检索词如下：“氯法齐明”、“结核病”、“耐多药结核病”或“广泛耐药结核病”及其同义词或类似词汇。两名研究人员独立筛选标题、摘要和全文以纳入研究。使用Stata 16.0版（美国德克萨斯州大学站市Stata公司）进行荟萃分析。计算95%置信区间的风险比（RRs）以评估治疗结果。
荟萃分析纳入了8项研究，共3219名参与者。荟萃分析发现，接受含氯法齐明方案治疗的患者的治疗完成率高于未接受含氯法齐明方案治疗的患者（RR：1.185（1.060 - 1.325），P = 0.003）。氯法齐明治疗组的治疗失败率显著降低（RR：0.598（0.473 - 0.756），P < 0.001）。随机对照试验（RCTs）的亚组分析发现，氯法齐明组的良好结局、治疗完成率和治愈率高于对照组（RR：1.203（1.029 - 1.407），P = 0.020；RR：3.167（2.043 - 4.908），P < 0.001；RR：1.251（1.031 - 1.518），P = 0.023）。接受氯法齐明治疗的患者治疗失败风险低于未接受氯法齐明治疗的患者（RR：0.529（0.454 - 0.616），P < 0.001）。然而，氯法齐明治疗对RCTs中的全因死亡率没有统计学显著影响。
本研究表明，与未接受氯法齐明治疗的患者相比，该药物在耐多药结核病病例中有可能实现更高的良好结局、治疗完成率和治愈率，以及更低的治疗失败风险。
