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

<a href="https://it.freepik.com/foto-gratuito/capsule-farmaceutiche-assortite-e-siringhe-con-sieri_11333180.htm#query=injection%20for%20tuberculosis&position=13&from_view=search&track=ais">Immagine di azerbaijan_stockers</a> su Freepik
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: 1548
PDF: 403
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

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.
Copyright (c) 2022 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.