Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada.
Faculty of Pharmacy, Université de Montréal, Montreal, Canada.
PLoS One. 2023 Oct 5;18(10):e0292106. doi: 10.1371/journal.pone.0292106. eCollection 2023.
Studying treatment duration for rifampicin-resistant and multidrug-resistant tuberculosis (MDR/RR-TB) using observational data is methodologically challenging. We aim to present a hypothesis generating approach to identify factors associated with shorter duration of treatment.
We conducted an individual patient data meta-analysis among MDR/RR-TB patients restricted to only those with successful treatment outcomes. Using multivariable linear regression, we estimated associations and their 95% confidence intervals (CI) between the outcome of individual deviation in treatment duration (in months) from the mean duration of their treatment site and patient characteristics, drug resistance, and treatments used.
Overall, 6702 patients with successful treatment outcomes from 84 treatment sites were included. We found that factors commonly associated with poor treatment outcomes were also associated with longer treatment durations, relative to the site mean duration. Use of bedaquiline was associated with a 0.51 (95% CI: 0.15, 0.87) month decrease in duration of treatment, which was consistent across subgroups, while MDR/RR-TB with fluoroquinolone resistance was associated with 0.78 (95% CI: 0.36, 1.21) months increase.
We describe a method to assess associations between clinical factors and treatment duration in observational studies of MDR/RR-TB patients, that may help identify patients who can benefit from shorter treatment.
使用观察性数据研究利福平耐药和耐多药结核病(MDR/RR-TB)的治疗持续时间在方法学上具有挑战性。我们旨在提出一种假设生成方法,以确定与治疗持续时间较短相关的因素。
我们对仅具有成功治疗结果的 MDR/RR-TB 患者进行了个体患者数据荟萃分析。使用多变量线性回归,我们估计了个体治疗持续时间偏差(以月为单位)与治疗地点和患者特征、药物耐药性和使用的治疗方法之间的结果之间的关联及其 95%置信区间(CI)。
总体而言,来自 84 个治疗地点的 6702 名成功治疗结局的患者被纳入研究。我们发现,与治疗结局不良相关的常见因素也与治疗持续时间延长有关,相对于治疗地点的平均持续时间。使用贝达喹啉与治疗持续时间减少 0.51 个月(95%CI:0.15,0.87)相关,这在各亚组中是一致的,而氟喹诺酮类耐药的 MDR/RR-TB 与治疗持续时间延长 0.78 个月(95%CI:0.36,1.21)相关。
我们描述了一种在 MDR/RR-TB 患者的观察性研究中评估临床因素与治疗持续时间之间关联的方法,这可能有助于识别可以从缩短治疗中受益的患者。