• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Chronic Disease

Shorter treatment regimen found to be noninferior for patients with multidrug resistant tuberculosis

byShani ChibberandRavi Shah, MD MBA
March 29, 2019
in Chronic Disease, Infectious Disease, Public Health, Pulmonology
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. A randomized control trial of patients with multidrug resistant tuberculosis found that shorter treatment regimens were noninferior to longer treatment regimens currently recommended by the WHO.

2. Severe adverse events were noted in both arms including death, QT interval prolongation and increases in alanine transaminase (ALT) levels.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Multidrug resistant tuberculosis requires aggressive treatment as it is resistant to two mainstay tuberculosis drugs – isoniazid and rifampin. In 2011, the World Health Organization (WHO) published a report indicating that long-term treatment lasting 20 months in duration was needed for disease management, however this report was not rooted in high quality analysis. New research has suggested that shorter length, aggressive treatment regimens may prove to be as beneficial in treating resistant tuberculosis as compared to the longer regimen. This current analysis strives to add to the current literature on the comparative effects of short-regimen therapy versus long-regimen therapy for patients with multidrug resistant tuberculosis. Researchers analyzed results from patients across sites in Ethiopia, Mongolia, South Africa and Vietnam, finding that short regimens of 9 to 11 months long were noninferior to longer regimens based on the number of participants in each arm that had negative M. tuberculosis cultures after 132 weeks post-randomization. Researchers also found that both arms were associated with adverse events, including QT interval changes and elevation in liver function test results. Overall, while these results suggest that shorter regimens of treatment may be as effective as longer treatment regimens, additional research is required to ensure the overall safety and efficacy of this treatment plan.

Click to read the study in NEJM

Click to read an accompanying editorial in NEJM

In-Depth [randomized control trial]: This multicenter, open-label, phase 3 randomized control trial randomized 707 patients between 2012-2015. Patients were assigned in a 2:1 ratio to receive either a short-regimen (9-11 months; n=282) or the WHO recommended long-regimen of tuberculosis medications (20 months; n=142). The short regimen consisted of moxifloxacin, clofazimine, ethambutol, pyrazinamide with supplemental kanamycin, isoniazid and protionamide. The primary endpoint of this study was evidence of favorable status at 132 weeks, defined by having negative cultures for M. tuberculosis at 132 weeks. Secondary outcomes included time to smear and culture conversions, and evidence of any acquired resistance to antibiotics. Safety profiles of each treatment arm were also compared and included an analysis of any death rates, severe adverse events, evidence of QT interval prolongation, and changes in liver function test results. Study participants were followed weekly for the first four weeks of treatment, and monthly thereafter through week 132. Of the initially randomized participants, 245 of the short-regimen group and 124 of the long-regimen group were included in the intention-to-treat analyses, and 227 of the short-regimen group and 83 of the long-regimen group were included in the per-protocol efficacy analysis. Favorable status in the intention-to treat population was noted among 193 of 245 patients (78.8%) of the short-regimen group and 99 of 124 participants (79.8%) in the long-regimen group (difference 1.0 percent; 95% CI -7.5 to 9.5; p=0.02 for noninferiority). Time to unfavorable outcomes were not significantly different between groups (HR 1.06; 95% CI 0.65-1.72). In the per protocol efficacy analysis, favorable status was noted in 67 of 83 participants (80.7%) in the long- regimen arm as compared to 186 of 227 participants in the short-regimen arm (81.9%; difference 0.7 percent; 95% CI -10.5-9.1; p=0.02 for noninferiority). Median conversion times to a negative smear or resistance rates to antibiotics did not differ significantly between groups. Severe adverse events occurred in 136 of 282 participants (48.2%) in the short-regimen group and in 64 of 141 participants (45.4%) in the long-regimen group. There were 24 deaths in the short-regimen group (8.5%) compared to 9 deaths (6.4%) in the long regimen group (HR 1.38; 95% CI 0.64 to 2.96). Increased QT intervals were noted among 11% of patients in the short-regimen group compared to 6.4% of patients in the long-regimen group (p=0.14). Increases in alanine transaminase levels were noted in 18 of 272 participants (6.6%) in the short-regimen group and in 2 of 139 participants (1.4%) in the long regimen group (HR 5.64; 95% CI 1.30 to 24.38; p=0.03).

RELATED REPORTS

#VisualAbstract: Non-severe tuberculosis in children can be treated with a shorter 4-month regimen instead of 6-month regimen

Non-severe tuberculosis in children can be treated with a shorter 4-month regimen

#VisualAbstract: Rifapentine-moxifloxacin noninferior to standard of care treatment for pulmonary tuberculosis

Image: PD

©2019 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: multidrug-resistant organismstuberculosis
Previous Post

Quick Take: Long-term outcome of surgery versus conservative management for recurrent and ongoing complaints after an episode of diverticulitis

Next Post

#VisualAbstract: Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients

RelatedReports

#VisualAbstract: COVID-19 vaccines provided durable protection from COVID-19, but their effectiveness waned over time in North Carolina
StudyGraphics

#VisualAbstract: Non-severe tuberculosis in children can be treated with a shorter 4-month regimen instead of 6-month regimen

April 13, 2022
Updated review confirms efficacy and safety of most standard treatments for latent tuberculosis infection
Chronic Disease

Non-severe tuberculosis in children can be treated with a shorter 4-month regimen

March 16, 2022
#VisualAbstract: Rifapentine-moxifloxacin noninferior to standard of care treatment for pulmonary tuberculosis
StudyGraphics

#VisualAbstract: Rifapentine-moxifloxacin noninferior to standard of care treatment for pulmonary tuberculosis

May 18, 2021
Updated review confirms efficacy and safety of most standard treatments for latent tuberculosis infection
Chronic Disease

Rifapentine-moxifloxacin noninferior to standard of care treatment for pulmonary tuberculosis

May 10, 2021
Next Post
#VisualAbstract: Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients

#VisualAbstract: Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients

Confounding influences phototherapy’s association with increased childhood cancer risk

Quick Take: Rates of extreme neonatal hyperbilirubinemia and kernicterus in children and adherence to national guidelines for screening, diagnosis, and treatment in Sweden

Variability in interpretation of breast biopsy slides associated with low verification of atypia and ductal carcinoma in situ

Combined anastrozole and fulvestrant therapy found to have improved survival outcomes in metastatic breast cancer

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Methamphetamine use associated with cardiovascular disease in hospitalized patients
  • Management of uncomplicated urinary tract infections amongst women in the United States Military Health System highly concordant with guidelines
  • Gout flares associated with a transient increase in subsequent risk of cardiovascular events
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.