What are the most efficacious treatment regimens for isoniazid-resistant tuberculosis? A systematic review and network meta-analysis
| Autor: | Katharina Kranzer, Marc Lipman, Ross J Harris, Nikolayevskyy, Ju Sang Kim, Obach D, Zhao H, Hollie-Ann Hatherell, Helen R. Stagg, Ibrahim Abubakar, Tsuchiya N |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Pulmonary and Respiratory Medicine medicine.medical_specialty Tuberculosis 030106 microbiology Antitubercular Agents MEDLINE 03 medical and health sciences 0302 clinical medicine Pharmacotherapy Randomized Controlled Trials as Topic/methods Internal medicine Drug Resistance Bacterial Isoniazid Credible interval Humans Medicine Clinical Epidemiology 030212 general & internal medicine Isoniazid/pharmacology Antitubercular Agents/pharmacology Randomized Controlled Trials as Topic Tuberculosis/drug therapy business.industry Mycobacterium tuberculosis/drug effects Mycobacterium tuberculosis Publication bias medicine.disease Regimen Meta-analysis Drug Therapy Combination business Publication Bias Rifampicin medicine.drug |
| Zdroj: | Thorax Stagg, H R, Harris, R J, Hatherell, H-A, Obach, D, Zhao, H, Tsuchiya, N, Kranzer, K, Nikolayevskyy, V, Kim, J, Lipman, M C & Abubakar, I 2016, ' What are the most efficacious treatment regimens for isoniazid-resistant tuberculosis? A systematic review and network meta-analysis ', Thorax, vol. 71, no. 10, pp. 940-9 . https://doi.org/10.1136/thoraxjnl-2015-208262 |
| ISSN: | 1468-3296 0040-6376 |
| DOI: | 10.1136/thoraxjnl-2015-208262 |
| Popis: | INTRODUCTION: Consensus on the best treatment regimens for patients with isoniazid-resistant TB is limited; global treatment guidelines differ. We undertook a systematic review and meta-analysis using mixed-treatment comparisons methodology to provide an up-to-date summary of randomised controlled trials (RCTs) and relative regimen efficacy.METHODS: Ovid MEDLINE, the Web of Science and EMBASE were mined using search terms for TB, drug therapy and RCTs. Extracted data were inputted into fixed-effects and random-effects models. ORs for all possible network comparisons and hierarchical rankings for different regimens were obtained.RESULTS: 12 604 records were retrieved and 118 remained postextraction, representing 59 studies-27 standalone and 32 with multiple papers. In comparison to a baseline category that included the WHO-recommended regimen for countries with high levels of isoniazid resistance (rifampicin-containing regimens using fewer than three effective drugs at 4 months, in which rifampicin was protected by another effective drug at 6 months, and rifampicin was taken for 6 months), extending the duration of rifampicin and increasing the number of effective drugs at 4 months lowered the odds of unfavourable outcomes (treatment failure or the lack of microbiological cure; relapse post-treatment; death due to TB) in a fixed-effects model (OR 0.31 (95% credible interval 0.12-0.81)). In a random-effects model all estimates crossed the null.CONCLUSIONS: Our systematic review and network meta-analysis highlight a regimen category that may be more efficacious than the WHO population level recommendation, and identify knowledge gaps where data are sparse.SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42014015025. |
| Databáze: | OpenAIRE |
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