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High success and low recurrence with shorter treatment regimen for multidrug-resistant TB in Nepal

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S. Koirala, N. P. Shah, P. Pyakurel, M. Khanal, S. K. Rajbhandari, T. Pun, B. Shrestha, B. Maharjan, S. Karki, S. Koirala, K. B. Tamang, A. Roggi,  A. M. V. Kumar, N. Ortuño-Gutiérrez


SETTING: Nine drug-resistant TB centres, some of them supported by Damien Foundation in Nepal where >80% of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) patients are treated.

OBJECTIVE: To assess the uptake, effectiveness and safety of the 9–11-month shorter treatment regimen (STR) in MDR/RR-TB patients registered from January 2018 to December 2019.

DESIGN: This was a cohort study involving secondary programme data.

RESULTS: Of 631 patients, 301 (48.0%) started and continued STR. Key reasons for ineligibility to start/continue STR were baseline resistance or exposure to second-line drugs (62.0%), contact with extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (7.0%) patients and unavailability of STR drugs (6.0%). Treatment success was 79.6%; unsuccessful outcomes were death (12.0%), lost to follow-up (5.3%), failure (2.7%) and not evaluated (0.7%). Unsuccessful outcomes were significantly associated with HIV positivity and patient age ≥55 years, with adjusted relative risk of respectively 2.39 (95% CI 1.52–3.77) and 3.86 (95% CI 2.30–6.46). Post-treatment recurrence at 6 and 12 months was respectively 0.5% and 2.4%. Serious adverse events (SAEs) were seen in 15.3% patients — hepatotoxicity and ototoxicity were most common.

CONCLUSION: STR had a modest uptake, high treatment success and low post-treatment recurrence. For proper detection and management of SAEs, improving pharmacovigilance might be considered. Availability of rapid diagnostic test for second-line drugs is crucial for correct patient management.


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