https://doi.org/10.4081/monaldi.2022.2396

Factors affecting the treatment outcome of injection based shorter MDR-TB regimen at a referral centre in India

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Vol. 93 No. 3 (2023)
Submitted: August 5, 2022
Accepted: September 27, 2022
Published: October 5, 2022
Multidrug resistant tuberculosis, MDR-TB shorter regimen, treatment outcome, mortality
Abstract Views: 1865
PDF: 511
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Authors

Kiran B
https://orcid.org/0000-0002-4282-4513
Department of Tuberculosis and Respiratory Diseases, National Institute Tuberculosis and Respiratory Disease, New Delhi, India.
Rupak Singla
drrupaksingla@yahoo.com
https://orcid.org/0000-0003-1806-8831
Department of Tuberculosis and Respiratory Diseases, National Institute Tuberculosis and Respiratory Disease, New Delhi, India.
Neeta Singla
https://orcid.org/0000-0002-1340-3146
Department of Epidemiology and Public Health, National Institute Tuberculosis and Respiratory Disease, New Delhi, India.
Vinay V
https://orcid.org/0000-0003-1691-2111
Department of Tuberculosis and Respiratory Diseases, National Institute Tuberculosis and Respiratory Disease, New Delhi, India.
Kuljeet Singh
https://orcid.org/0000-0002-4160-1465
Department of Tuberculosis and Respiratory Diseases, National Institute Tuberculosis and Respiratory Disease, New Delhi, India.
Madhumita Paul Choudhury
https://orcid.org/0000-0003-2271-9393
Department of Tuberculosis and Respiratory Diseases, National Institute Tuberculosis and Respiratory Disease, New Delhi, India.
Nilotpal Bhattacherjee
https://orcid.org/0000-0001-9342-3093
Department of Tuberculosis and Respiratory Diseases, National Institute Tuberculosis and Respiratory Disease, New Delhi, India.

Rifampicin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) is a significant burden on global tuberculosis (TB) prevention and eradication efforts. MDR-TB can be treated, but it is expensive, takes a long time (typically two years) and contains potentially toxic drugs. Under certain conditions, the WHO recommends standard regimens lasting 9 to 11 months rather than individual regimens lasting at least 18-20 months. The current study sought to identify factors associated with treatment outcomes in RR/MDR-TB patients receiving an injection-based regimen for 9-11 months. This ambispective (prospective and retrospective) observational study was conducted at a tertiary tuberculosis institute in New Delhi, India. Between February 2021 and March 2022, patients with RR/MDR-pulmonary TB who received an injection-based shorter regimen were enrolled. Factors related to treatment outcomes were investigated and compared in patients who had a successful outcome versus those who did not. A total of 55 patients were enrolled, with 50.91% being successful (cured/treatment completed) and 49.09% failing (including failure, lost to follow up, death, and regimen change). The following factors were significantly associated with the unsuccessful outcome, according to univariate analysis: BMI (<18.5 kg/m2), anaemia, previous anti-TB treatment, bilateral chest X-ray involvement, and far advanced disease on chest X-ray. BMI (<18.5 kg/m2), anaemia, and far advanced disease on chest X-ray were all significantly associated with mortality. Anaemia was associated with an unsuccessful outcome (p=0.049) and mortality (p=0.048) in the multiple logistic regression analysis. Early treatment initiation, improved nutrition and anaemia, and regular monitoring can all improve RR/MDR-TB patients’ outcomes and prognoses.

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
World Health Organization. Global TB report 2021. Available from: https://www.who.int/publications/i/item/9789240037021
World Health Organization. WHO consolidated guidelines on drug-resistant tuberculosis treatment Geneva2019. Available from: https://www.who.int/tb/publications/2019/consolidated-guidelines-drug-resistant-TBtreatment/en/ DOI: https://doi.org/10.4103/ijmr.IJMR_579_19
World Health Organization, Global Tuberculosis Programme. WHO treatment guidelines for drug-resistant tuberculosis: 2016 update. Available from: http://www.ncbi.nlm.nih.gov/books/NBK390455/
Central TB Division. Guideline for programmatic management of drug resistance TB (PMDT) in India, 2017. Available from: https://tbcindia.gov.in/index1.php?lang=1&level=2&sublinkid=4780&lid=3306
Aung KJM, van Deun A, Declercq E, et al. Successful ‘9-month Bangladesh regimen’ for multidrug-resistant tuberculosis among over 500 consecutive patients. The International J Tuberc Lung Dis 2014;18:1180–7. DOI: https://doi.org/10.5588/ijtld.14.0100
Sharma R. Revised Kuppuswamy’s socioeconomic status scale: Explained and updated. Indian Pediatr 2017:S097475591600090 Online ahead of print DOI: https://doi.org/10.1007/s13312-017-1151-x
National Tuberculosis Association. Diagnostic standards and classification of tuberculosis. 11th ed. National Tuberculosis Association: New York; 1961.
Chandrasekaran P, Saravanan N, Bethunaickan R, Tripathy S. Malnutrition: Modulator of immune responses in tuberculosis. Front Immunol 2017;8:1316. DOI: https://doi.org/10.3389/fimmu.2017.01316
Gupta K, Gupta R, Atreja A, et al. Tuberculosis and nutrition. Lung India 2009;26:9. DOI: https://doi.org/10.4103/0970-2113.45198
Piubello A, Harouna SH, Souleymane MB, et al. High cure rate with standardised short-course multidrug-resistant tuberculosis treatment in Niger: no relapses. Int J Tuberc Lung Dis 2014;18:1188–94. DOI: https://doi.org/10.5588/ijtld.13.0075
Soeroto AY, Nurhayati RD, Purwiga A, et al. Factors associated with treatment outcome of MDR/RR-TB patients treated with shorter injectable based regimen in West Java Indonesia. PLoS One 2022;17:e0263304. DOI: https://doi.org/10.1371/journal.pone.0263304
Singla R, Raghu B, Gupta A, et al. Risk factors for early mortality in patients with pulmonary tuberculosis admitted to the emergency room. Pulmonology 2021;27:35-42. DOI: https://doi.org/10.1016/j.pulmoe.2020.02.002
Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood 2019;133:40–50. DOI: https://doi.org/10.1182/blood-2018-06-856500
Bahi GA, Bidie AP, Meite S, Djaman AJ. Exploring the iron metabolism in multidrug resistant tuberculosis (MDR-TB) patients in treatment. Intl J Biol Chem Sci 2017;11:1039–45. DOI: https://doi.org/10.4314/ijbcs.v11i3.9
Ministry of Health and Family Welfare, Government of India. Guidelines for control of iron deficiency anaemia. 2013 update. Available from: https://www.nhm.gov.in/images/pdf/programmes/child-health/guidelines/Control-of-Iron-Deficiency-Anaemia.pdf
O’Brien ME, Kupka R, Msamanga GI, et al. Anemia is an independent predictor of mortality and immunologic progression of disease among women with HIV in Tanzania. J Acquir Immune Deficy Syndr 2005;40:219–25. DOI: https://doi.org/10.1097/01.qai.0000166374.16222.a2
Gelaw Y, Getaneh Z, Melku M. Anemia as a risk factor for tuberculosis: a systematic review and meta-analysis. Environl Health Prev Med 2021;26:1–15. DOI: https://doi.org/10.1186/s12199-020-00931-z
Johnson JM, Mohapatra AK, Velladath SU, Shettigar KS. Predictors of treatment outcomes in drug resistant tuberculosis-observational retrospective study. Int J Mycobacteriol 2022;11:38-46.
Dheda K, Gumbo T, Maartens G, et al. The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. Lancet Respir Med 2017;5:291–360. DOI: https://doi.org/10.1016/S2213-2600(17)30079-6
Falzon D, Schünemann HJ, Harausz E, et al. World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update. Eur Respir J 2017;49:1602308. DOI: https://doi.org/10.1183/13993003.02308-2016
Gadallah MA, Mokhtar A, Rady M, et al. Prognostic factors of treatment among patients with multidrug-resistant tuberculosis in Egypt. J Formos Med Assoc 2016;115:997-1003. DOI: https://doi.org/10.1016/j.jfma.2015.10.002
Kim CW, Kim SH, Lee SN, et al. Risk factors related with mortality in patient with pulmonary tuberculosis. Tuberc Respir Dis 2012;73:38. DOI: https://doi.org/10.4046/trd.2012.73.1.38
Eshetie S, Gizachew M, Dagnew M, et al. Multidrug resistant tuberculosis in Ethiopian settings and its association with previous history of anti-tuberculosis treatment: a systematic review and meta-analysis. BMC Infect Dis 2017;17:219. DOI: https://doi.org/10.1186/s12879-017-2323-y
Nagu TJ, Mboka MA, Nkrumbih ZF, et al. Clinical and imaging features of adults with recurrent pulmonary tuberculosis - A prospective case-controlled study. Int J Infect Dis 2021;113:S33–9. DOI: https://doi.org/10.1016/j.ijid.2021.01.071
Wahid A, Ahmad N, Ghafoor A, et al. Effectiveness of shorter treatment regimen in multidrug-resistant tuberculosis patients in Pakistan: A multicenter retrospective record review. Am J Trop Med Hyg 2021;104:1784–91. DOI: https://doi.org/10.4269/ajtmh.20-1134
Tola HH, Holakouie-Naieni K, Mansournia MA, Yaseri M, et al. Intermittent treatment interruption and its effect on multidrug resistant tuberculosis treatment outcome in Ethiopia. Sci Rep 2019;9:20030. DOI: https://doi.org/10.1038/s41598-019-56553-1

How to Cite

B, Kiran, Rupak Singla, Neeta Singla, Vinay V, Kuljeet Singh, Madhumita Paul Choudhury, and Nilotpal Bhattacherjee. 2022. “Factors Affecting the Treatment Outcome of Injection Based Shorter MDR-TB Regimen at a Referral Centre in India”. Monaldi Archives for Chest Disease 93 (3). https://doi.org/10.4081/monaldi.2022.2396.
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