Group 5 drugs for multidrug-resistant tuberculosis: individual patient data meta-analysis. Issue 1 (3rd January 2017)

• Record Type: Journal Article
• Authors: Fox, Greg J.; Benedetti, Andrea; Cox, Helen; Koh, Won-Jung; Viiklepp, Piret; Ahuja, Shama; Pasvol, Geoffrey; Menzies, Dick
• Is Part Of: European respiratory journal. Volume 49:Issue 1(2017)
• Publication Date: 2017-01-03
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.00993-2016
• Languages: English
• ISSNs: 0903-1936

Abstract

The role of so-called "group 5" second-line drugs as a part of antibiotic therapy for multidrug-resistant tuberculosis (MDR-TB) is widely debated. We performed an individual patient data meta-analysis to evaluate the effectiveness of several group 5 drugs including amoxicillin/clavulanic acid, thioacetazone, the macrolide antibiotics, linezolid, clofazimine and terizidone for treatment of patients with MDR-TB. Detailed individual patient data were obtained from 31 published cohort studies of MDR-TB therapy. Pooled treatment outcomes for each group 5 drug were calculated using a random effects meta-analysis. Primary analyses compared treatment success to a combined outcome of failure, relapse or death. Among 9282 included patients, 2191 received at least one group 5 drug. We found no improvement in treatment success among patients taking clofazimine, amoxicillin/clavulanic acid or macrolide antibiotics, despite applying a number of statistical approaches to control confounding. Thioacetazone was associated with increased treatment success (OR 2.6, 95% CI 1.1–6.1) when matched controls were selected from studies in which the group 5 drugs were not used at all, although this result was heavily influenced by a single study. The development of more effective antibiotics to treat drug-resistant TB remains an urgent priority. A meta-analysis of patient data found that group 5 drugs have limited benefit in treating patients with MDR-TB http://ow.ly/TIrH304QBci