Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
J Infect. 2023 Sep;87(3):177-189. doi: 10.1016/j.jinf.2023.06.014. Epub 2023 Jun 23.
Historically, extensively drug-resistant tuberculosis has been notoriously difficult to treat with devasting outcomes. As we are coming to the end of an era where the 2006 extensively drug-resistant tuberculosis definitions and old treatment regimens are being replaced, we aimed to estimate the proportion of extensively drug-resistant tuberculosis patients globally who achieved successful treatment outcomes.
We conducted a systematic review of PubMed/MEDLINE, Scopus, Web of Science, and Embase from January 1, 2005, through April 3, 2023. Included studies reported WHO treatment outcomes, or adaptions hereof, for pre-extensively and/or extensively drug-resistant tuberculosis patients according to the 2006 WHO definition. Eligible studies included cohorts of at least 10 adults (aged>18 years) that were not pregnant. Using a random-effects model, we calculated pooled proportions of treatment outcomes and performed sensitivity and subgroup analyses. PROSPERO registration number: CRD42022340961.
Among 5056 studies reviewed, we identified 94 studies from 26 countries, involving 10,223 extensively drug-resistant tuberculosis patients. The pooled proportion of successful treatment outcomes was 44.2% (95%CI: 38.3-50.3). Sensitivity analyses consistently produced similar estimates. A slight improvement in treatment outcomes was observed after 2013. Furthermore, 25 studies reported outcomes for 3564 individuals with pre-extensively drug-resistant tuberculosis, of which 63.3% achieved successful treatment (95%CI: 43.1-72.5).
Globally, the success rate of extensively drug-resistant tuberculosis treatment is 44.2%, far below the WHO's target rate of 75%. These results may serve as a reference for future studies assessing extensively drug-resistant tuberculosis treatment outcomes under the 2021 definition treated with better treatment regimens available. Comprehensive surveillance data of extensively drug-resistant tuberculosis outcomes from the whole world are desirable to monitor treatment progress.
从历史上看，广泛耐药结核病的治疗极具挑战性，结果往往惨不忍睹。随着我们即将结束一个时代，在这个时代，2006 年广泛耐药结核病的定义和旧的治疗方案正在被取代，我们旨在估计全球广泛耐药结核病患者中成功治疗结果的比例。
我们对 2005 年 1 月 1 日至 2023 年 4 月 3 日期间的 PubMed/MEDLINE、Scopus、Web of Science 和 Embase 进行了系统综述。纳入的研究根据 2006 年世卫组织的定义，报告了广泛耐药和/或耐多药结核病患者的世卫组织治疗结果或其改编结果。合格的研究包括至少有 10 名成年人（年龄>18 岁）的队列，且这些人没有怀孕。我们使用随机效应模型计算了治疗结果的汇总比例，并进行了敏感性和亚组分析。PROSPERO 注册号：CRD42022340961。
在审查的 5056 项研究中，我们从 26 个国家确定了 94 项研究，涉及 10223 名广泛耐药结核病患者。成功治疗结果的汇总比例为 44.2%（95%CI：38.3-50.3）。敏感性分析始终产生类似的估计值。2013 年后，治疗结果略有改善。此外，25 项研究报告了 3564 名耐多药结核病患者的结果，其中 63.3%的患者获得了成功治疗（95%CI：43.1-72.5）。
在全球范围内，广泛耐药结核病治疗的成功率为 44.2%，远低于世卫组织 75%的目标。这些结果可以为未来根据 2021 年定义使用更好的治疗方案治疗广泛耐药结核病的治疗结果评估研究提供参考。从全球范围来看，广泛耐药结核病结局的综合监测数据是监测治疗进展的理想选择。
