Matinum

Taking Charge of Your Health


Multidrug-resistant tuberculosis, resistant
to isoniazid and rifampin, is diagnosed in almost half-a-million new people each year. The World Health Organization recommends a
20-month treatment course, but cohort studies in Bangladesh have shown promising results
in multidrug-resistant tuberculosis using shorter regimens. This randomized, noninferiority trial of
participants with rifampin-resistant TB susceptible to fluoroquinolones and aminoglycosides
compared a 9- 11-month course of treatment containing high-dose moxifloxacin (the short
regimen) with the WHO-recommended 20-month course of treatment (the long regimen). The primary outcome, or favorable outcome,
was defined as culture negativity during treatment and at 132 weeks post-randomization without
an intervening positive culture or unfavorable outcome. An unfavorable outcome was defined as: starting
two or more drugs not in the allocated regimen; treatment extension beyond the permitted duration;
death from any cause; a positive culture result when last seen; or not seen at 76 weeks or
later. In a modified intention-to-treat analysis, 78.8% of those in the short regimen group had a favorable outcome as compared with
79.8% of those in the long regimen group, for an HIV-adjusted difference of 1 percentage point. The 95% confidence interval did not exceed
the 10-percentage point margin of non-inferiority. Both regimens had a similar frequency of severe
adverse events. An increased corrected QT interval developed more frequently in patients on the short regimen. The authors conclude that in patients with
MDR-TB susceptible to fluoroquinolones or aminoglycosides, a short 9- 11-month regimen
had non-inferior efficacy and comparable safety to the WHO-recommended longer regimen. Full trial results are available at NEJM.org.

One thought on “Treating Multidrug-Resistant Tuberculosis

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