Khan Sumaiya, Silsarma Arunima, Mahajan Raman, Khan Shahid, Davuluri Praveen, Sutar Narendra, Iyer Aparna, Mankar Shubhangi, Oswal Vikas, Puri Varsha, Shah Daksha, Chavan Vijay, Spencer Hannah, Isaakidis Petros
Médecins Sans Frontières, Mumbai, India.
National Tuberculosis Elimination Program, Mumbai, India.
J Clin Tuberc Other Mycobact Dis. 2024 Oct 12;37:100481. doi: 10.1016/j.jctube.2024.100481. eCollection 2024 Dec.
Tuberculosis (TB) remains a significant cause of mortality globally, with India accounting for 27% of the estimated number of people with TB. Multidrug-resistant TB (MDR-TB) and isoniazid (INH) resistance pose additional challenges to effective treatment. We aimed to describe treatment outcomes of INH mono-resistant TB patients under programmatic conditions in Mumbai, India.
This retrospective cohort study was conducted at Shatabdi Hospital in Mumbai between 2019-2021.We described the clinical and demographic characteristics, treatment outcomes, and risk factors for unfavourable outcomes among patients with INH mono-resistant TB treated with rifampicin, ethambutol, pyrazinamide, and levofloxacin (LfxREZ) for a duration of 6 months.
Among 3105 patients with drug-resistant TB initiated on treatment, 217 (7 %) had INH mono-resistant TB. Of these, 54 % (117/217) were female, with a median age of 26 years (interquartile range: 20-40). The majority (88 %; 191/217) presented with pulmonary TB, and most (87 %; 188/217) had favourable treatment outcomes, including treatment completion (52 %; 112/217) and cure (35 %; 76/217). Unfavourable outcomes, including treatment failure (2.3 %; 5/217), loss to follow-up (9.2 %; 20/217), or death (1.8 %; 4/217), were observed in 13 % (29/217) of patients. A total of ten (5 %) patients experienced at least one non-severe adverse drug reaction. Factors associated with unfavourable outcomes included severe thinness (p = 0.019) and male gender (p = 0.012).
Treating INH mono-resistant patients with LfxREZ resulted in satisfactory outcomes and low toxicity. It is important to rule out drug resistance to INH while determining the treatment regimen.
结核病仍然是全球死亡的一个重要原因，印度的结核病估计患者人数占全球的27%。耐多药结核病（MDR-TB）和对异烟肼（INH）耐药给有效治疗带来了额外挑战。我们旨在描述印度孟买在项目条件下异烟肼单耐药结核病患者的治疗结果。
这项回顾性队列研究于2019年至2021年在孟买的沙塔迪医院进行。我们描述了接受利福平、乙胺丁醇、吡嗪酰胺和左氧氟沙星（LfxREZ）治疗6个月的异烟肼单耐药结核病患者的临床和人口统计学特征、治疗结果以及不良结果的危险因素。
在3105例开始接受治疗的耐药结核病患者中，217例（7%）为异烟肼单耐药结核病。其中，54%（117/217）为女性，中位年龄为２６岁（四分位间距：20-40）。大多数（88%；191/217）表现为肺结核，大多数（87%；188/217）治疗结果良好，包括完成治疗（52%；112/217）和治愈（35%；76/217）。13%（29/217）的患者出现了不良结果，包括治疗失败（2.3%；5/217）、失访（9.2%；20/217）或死亡（1.8%；4/217）。共有10例（5%）患者经历了至少一次非严重药物不良反应。与不良结果相关的因素包括严重消瘦（p = 0.019）和男性（p = 0.012）。
用LfxREZ治疗异烟肼单耐药患者取得了满意的结果且毒性较低。在确定治疗方案时，排除对异烟肼的耐药性很重要。
