Treatment of isoniazid-resistant tuberculosis with first-line drugs: a systematic review and meta-analysis

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• 作者：Medea Gegia ; MD^a ; Nicholas Winters ; MSc^b ; Andrea Benedetti ; PhD^b ; Prof Dick van Soolingen ; MD^c ; Prof Dick Menzies ; MD^b ; ^{dick.menzies@mcgill.ca}
• 刊名：The Lancet Infectious Diseases
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：17
• 期：2
• 页码：223-234
• 全文大小：465 K
• 卷排序：17

文摘

The results of some reports have suggested that treatment of isoniazid-resistant tuberculosis with the recommended regimens of first-line drugs might be suboptimal. We updated a previous systematic review of treatment outcomes associated with use of first-line drugs in patients with tuberculosis resistant to isoniazid but not rifampicin.MethodsIn this systematic review, we updated the results of a previous review to include randomised trials and cohort studies published in English, French, or Spanish to March 31, 2015, containing results of standardised treatment of patients with bacteriologically confirmed isoniazid-resistant tuberculosis (but not multidrug-resistant tuberculosis—ie, not resistant to rifampicin) in whom failure and relapse were bacteriologically confirmed. Results in patients with drug-sensitive tuberculosis included in the same studies were also analysed. We pooled treatment outcomes with random-effects meta-analysis.FindingsWe identified 19 cohort studies and 33 trials with 3744 patients with isoniazid-resistant tuberculosis and 19 012 patients with drug-sensitive disease. The pooled rates of failure or relapse, or both, and acquired drug resistance with all drug regimens were 15% (95% CI 12–18) and 3·6% (2–5), respectively, in patients with isoniazid-resistant tuberculosis and 4% (3–5) and 0·6% (0·3–0·9) in those with drug-sensitive tuberculosis. Of patients with initial isoniazid-resistant tuberculosis with acquired drug resistance, 96% (93–99) had acquired multidrug-resistant disease. Treatment of isoniazid-resistant tuberculosis with the WHO standard regimen for new patients resulted in treatment failure, relapse, and acquired multidrug resistance in 11% (6–17), 10% (5–15) and 8% (3–13), respectively; treatment with the standard WHO regimen for previously treated patients resulted in treatment failure in 6% (2–10), relapse in 5% (2–8), and acquisition of multidrug resistance in 3% (0–6). For patients with drug-sensitive disease treated with the standard retreatment regimen the rates were 1% (0–2), 5% (4–7), and 0·3% (0–0·6).InterpretationTreatment of isoniazid-resistant tuberculosis with first-line drugs resulted in suboptimal outcomes, supporting the need for better regimens. Standardised empirical treatment of new cases could be contributing substantially to the multidrug-resistant epidemic, particularly in settings where the prevalence of isoniazid resistance is high.FundingCanadian Institutes of Health Research.