Simanjuntak Arya M, Daenansya Raehan, Aflandhanti Putri M, Yovi Indra, Suyanto Suyanto, Anggraini Dewi, Rosdiana Dani
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia.
Department of Pulmonology and Respiratory Medicine, Arifin Achmad General Hospital, Pekanbaru, Indonesia.
Narra J. 2023 Dec;3(3):e402. doi: 10.52225/narra.v3i3.402. Epub 2023 Nov 13.
Concerns regarding the rise of drug-resistant tuberculosis (DR-TB) infections and the need for new drugs with shorter treatment time and fewer side effects have been voiced by the World Health Organization (WHO). The WHO revised its guideline to treat multidrug resistant tuberculosis (MDR-TB) with a 6-month course of BPaLM (bedaquiline, pretomanid, linezolid and moxifloxacin) in 2022. However, a thorough study and meta-analysis of available evidence is required due to the limited confidence of the evidence confirming the effectiveness of pretomanid-containing regiments. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of pretomanid-containing regiments in treating DR-TB patients. Data from six search engines were searched using inclusion criteria based on the PICOS framework. The keywords of pretomanid and tuberculosis or their alternatives were used. Using RoB2 Cochrane risk-of-bias tool for randomized clinical trials, data were independently extracted and the quality of the data was evaluated. Odds ratio (OR) and heterogeneity tests were used and the findings were presented in ORs and forest plots. A total of four studies with 237 patients was included in the final analysis and 204 (86%) patients had favorable outcome (cured) and 33 (14%) was not cured. Pretomanid-containing regimen (OR: 46.73; 95%CI: 11.76-185.7) and BPaLM/BPaL (OR: 41.67; 95%CI: 8.86-196.73) regimens were associated with favorable outcome (cured). This meta-analysis indicates that the pretomanid-containing regimen and the BPaLM/BPaL regimen could increase the chance to have favorable outcome in DR-TB patients.
世界卫生组织（WHO）已表达了对耐药结核病（DR-TB）感染增加的担忧，以及对具有更短治疗时间和更少副作用的新药的需求。WHO在2022年修订了其治疗耐多药结核病（MDR-TB）的指南，采用6个月疗程的BPaLM（贝达喹啉、普瑞玛尼、利奈唑胺和莫西沙星）。然而，由于确认含普瑞玛尼方案有效性的证据可信度有限，需要对现有证据进行全面研究和荟萃分析。本系统评价和荟萃分析的目的是评估含普瑞玛尼方案治疗DR-TB患者的有效性。使用基于PICOS框架的纳入标准在六个搜索引擎中检索数据。使用了普瑞玛尼和结核病或其替代词的关键词。使用RoB2 Cochrane随机临床试验偏倚风险工具，独立提取数据并评估数据质量。使用比值比（OR）和异质性检验，并在OR值和森林图中呈现结果。最终分析共纳入四项研究，涉及237名患者，其中204名（86%）患者获得良好结局（治愈），33名（14%）未治愈。含普瑞玛尼方案（OR：46.73；95%CI：11.76 - 185.7）和BPaLM/BPaL方案（OR：41.67；95%CI：8.86 - 196.73）与良好结局（治愈）相关。该荟萃分析表明，含普瑞玛尼方案和BPaLM/BPaL方案可增加DR-TB患者获得良好结局的机会。
