Journal Article > LetterFull Text
Am J Respir Crit Care Med. 2015 February 1; Volume 191 (Issue 3); 355-358.; DOI:10.1164/rccm.201407-1302LE
Bastard M, Bonnet MMB, du Cros PAK, Khamraev AK, Hayrapetyan A, et al.
Am J Respir Crit Care Med. 2015 February 1; Volume 191 (Issue 3); 355-358.; DOI:10.1164/rccm.201407-1302LE
Journal Article > ResearchFull Text
J Infect Dis. 2014 October 13; Volume 211 (Issue 10); DOI:10.1093/infdis/jiu551
Bastard M, Sanchez-Padilla E, Hewison CCH, Hayrapetyan A, Khurkhumal S, et al.
J Infect Dis. 2014 October 13; Volume 211 (Issue 10); DOI:10.1093/infdis/jiu551
The success of the current treatment regimen for multidrug-resistant tuberculosis (MDR-TB) is poor partly due to a high defaulter rate. Many studies explored predictors of poor outcomes, but very few assessed the impact of treatment interruptions on MDR-TB treatment outcomes.
Journal Article > ResearchFull Text
PLOS One. 2018 March 8; Volume 13 (Issue 3); DOI:10.1371/journal.pone.0193491
Bastard M, Sanchez-Padilla E, du Cros PAK, Khamraev AK, Parpieva N, et al.
PLOS One. 2018 March 8; Volume 13 (Issue 3); DOI:10.1371/journal.pone.0193491
The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance.
Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 2016 February 1; Volume 20 (Issue 2); 177-186.; DOI:10.5588/ijtld.15.0962
Bonnet MMB, Bastard M, du Cros PAK, Khamraev AK, Kimenye K, et al.
Int J Tuberc Lung Dis. 2016 February 1; Volume 20 (Issue 2); 177-186.; DOI:10.5588/ijtld.15.0962
BACKGROUND
The World Health Organization recommends adding bedaquiline or delamanid to multidrug-resistant tuberculosis (MDR-TB) regimens for which four effective drugs are not available, and delamanid for patients at high risk of poor outcome.
OBJECTIVE
To identify patients at risk of unfavourable outcomes who may benefit from the new drugs.
METHODS
Retrospective cohort study of treatment outcomes involving four to five effective drugs for 15–24 months in programmes in Uzbekistan, Georgia, Armenia, Swaziland and Kenya between 2001 and 2011.
RESULTS
Of 1433 patients, 48.5% had body mass index (BMI) <18.5 kg/m2, 72.9% had a high bacillary load, 16.7% were resistant to two injectables, 2.9% were resistant to ofloxacin (OFX) and 3.0% had extensively drug-resistant TB (XDR-TB). Treatment success ranged from 59.7% (no second-line resistance) to 27.0% (XDR-TB). XDR-TB (aOR 8.16, 95%CI 3.22–20.64), resistance to two injectables (aOR 1.90, 95%CI 1.00–3.62) or OFX (aOR 5.56, 95%CI 2.15–14.37), past incarceration (aOR 1.88, 95%CI 1.11–3.2), history of second-line treatment (aOR 3.24, 95%CI 1.53–6.85), low BMI (aOR 2.22, 95%CI 1.56–3.12) and high bacillary load (aOR 2.32, 95%CI 1.15–4.67) were associated with unfavourable outcomes. Patients started on capreomycin rather than kanamycin were more likely to have an unfavourable outcome (aOR 1.54, 95%CI 1.04–2.28).
CONCLUSION
In our cohort, patients who may benefit from bedaquiline and delamanid represented up to two thirds of all MDR-TB patients.
The World Health Organization recommends adding bedaquiline or delamanid to multidrug-resistant tuberculosis (MDR-TB) regimens for which four effective drugs are not available, and delamanid for patients at high risk of poor outcome.
OBJECTIVE
To identify patients at risk of unfavourable outcomes who may benefit from the new drugs.
METHODS
Retrospective cohort study of treatment outcomes involving four to five effective drugs for 15–24 months in programmes in Uzbekistan, Georgia, Armenia, Swaziland and Kenya between 2001 and 2011.
RESULTS
Of 1433 patients, 48.5% had body mass index (BMI) <18.5 kg/m2, 72.9% had a high bacillary load, 16.7% were resistant to two injectables, 2.9% were resistant to ofloxacin (OFX) and 3.0% had extensively drug-resistant TB (XDR-TB). Treatment success ranged from 59.7% (no second-line resistance) to 27.0% (XDR-TB). XDR-TB (aOR 8.16, 95%CI 3.22–20.64), resistance to two injectables (aOR 1.90, 95%CI 1.00–3.62) or OFX (aOR 5.56, 95%CI 2.15–14.37), past incarceration (aOR 1.88, 95%CI 1.11–3.2), history of second-line treatment (aOR 3.24, 95%CI 1.53–6.85), low BMI (aOR 2.22, 95%CI 1.56–3.12) and high bacillary load (aOR 2.32, 95%CI 1.15–4.67) were associated with unfavourable outcomes. Patients started on capreomycin rather than kanamycin were more likely to have an unfavourable outcome (aOR 1.54, 95%CI 1.04–2.28).
CONCLUSION
In our cohort, patients who may benefit from bedaquiline and delamanid represented up to two thirds of all MDR-TB patients.
Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 2019 October 1; Volume 23 (Issue 10); 1060-1067(8).; DOI:10.5588/ijtld.18.0649
Bastard M, Sanchez-Padilla E, Hayrapetyan A, Kimenye K, Khurkhumal S, et al.
Int J Tuberc Lung Dis. 2019 October 1; Volume 23 (Issue 10); 1060-1067(8).; DOI:10.5588/ijtld.18.0649
INTRODUCTION
Identification of good prognostic marker for tuberculosis (TB) treatment response is a necessary step on the path towards a surrogate marker to reduce TB trial duration.
METHODS
We performed a retrospective analysis on routinely collected data in 6 drug-resistant TB (DRTB) programs. Culture conversion, defined as two consecutive negative cultures, was assessed, and performance of culture conversion at Month 2 and Month 6 to predict treatment success were explored. To explore factors associated with positive predicted value (PPV) and the specificity of culture conversion, a multinomial logistic regression was fitted.
RESULTS
This study included 634 patients: 68.5% were males; the median age was 35 years, 75.2% were previously treated for TB, 59.4% were resistant only to isoniazid and rifampicin and 18.1% resistant to fluoroquinolones. Culture conversion at Month 2 and 6 showed similar PPV while specificity was much higher for culture conversion at Month 2: 91.3% (95%CI 86.1–95.1). PPV of culture conversion at Month 2 did not vary strongly according to patients' characteristics, while specificity was slightly higher among patients with fluoroquinolone-resistant strains.
CONCLUSION
Culture conversion at Month 2 is an acceptable prognostic marker for MDR-TB treatment. Considering the advantage of using an earlier marker, further evaluation as a surrogate marker is warranted to shorten TB trials.
Identification of good prognostic marker for tuberculosis (TB) treatment response is a necessary step on the path towards a surrogate marker to reduce TB trial duration.
METHODS
We performed a retrospective analysis on routinely collected data in 6 drug-resistant TB (DRTB) programs. Culture conversion, defined as two consecutive negative cultures, was assessed, and performance of culture conversion at Month 2 and Month 6 to predict treatment success were explored. To explore factors associated with positive predicted value (PPV) and the specificity of culture conversion, a multinomial logistic regression was fitted.
RESULTS
This study included 634 patients: 68.5% were males; the median age was 35 years, 75.2% were previously treated for TB, 59.4% were resistant only to isoniazid and rifampicin and 18.1% resistant to fluoroquinolones. Culture conversion at Month 2 and 6 showed similar PPV while specificity was much higher for culture conversion at Month 2: 91.3% (95%CI 86.1–95.1). PPV of culture conversion at Month 2 did not vary strongly according to patients' characteristics, while specificity was slightly higher among patients with fluoroquinolone-resistant strains.
CONCLUSION
Culture conversion at Month 2 is an acceptable prognostic marker for MDR-TB treatment. Considering the advantage of using an earlier marker, further evaluation as a surrogate marker is warranted to shorten TB trials.