Clinical management of multidrug-resistant tuberculosis in 16 european countries

Gunar Günther, Frank Van Leth, Sofia Alexandru, Neus Altet, Korkut Avsar, Didi Bang, Raisa Barbuta, Graham Bothamley, Ana Ciobanu, Valeriu Crudu, Manfred Danilovits, Martin Dedicoat, Raquel Duarte, Gina Gualano, Heinke Kunst, Wiel De Lange, TBnet

Research output: Contribution to journalArticle

Abstract

Rationale: Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. Objectives: To document the management and treatment outcome in patients with MDR-TB in Europe. Methods: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). Measurements and Main Results: A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). Conclusions: Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.

Original languageEnglish
Pages (from-to)379-386
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume198
Issue number3
DOIs
Publication statusPublished - Aug 1 2018

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Keywords

  • Extensively drug-resistant TB
  • Management
  • MDR-TB
  • Outcome definitions
  • TBNET

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Günther, G., Van Leth, F., Alexandru, S., Altet, N., Avsar, K., Bang, D., Barbuta, R., Bothamley, G., Ciobanu, A., Crudu, V., Danilovits, M., Dedicoat, M., Duarte, R., Gualano, G., Kunst, H., De Lange, W., & TBnet (2018). Clinical management of multidrug-resistant tuberculosis in 16 european countries. American Journal of Respiratory and Critical Care Medicine, 198(3), 379-386. https://doi.org/10.1164/rccm.201710-2141OC