Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Marks, Suzanne M. ; Mase, Sundari R. ; Morris, Sapna Bamrah
• Description:
  Background
  
  Evidence-based recommendations for treating persons having presumed latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) tuberculosis (TB) are lacking because published data consist of small observational studies. Tuberculosis incidence in persons treated for latent MDR -TB infection is unknown.
  
  Methods
  
  We conducted a systematic review of studies published 1 January 1994–31 December 2014 to analyze TB incidence, treatment completion and discontinuation, and cost-effectiveness. We considered contacts with LTBI effectively treated if they were on ≥1 medication to which their MDR-TB strain was likely susceptible. We selected studies that compared treatment vs nontreatment outcomes and performed a meta-analysis to estimate the relative risk of TB incidence and its 95% confidence interval.
  
  Results
  
  We abstracted data from 21 articles that met inclusion criteria. Six articles presented outcomes for contacts who were treated compared with those not treated for MDR-LTBI; 10 presented outcomes only for treated contacts, and 5 presented outcomes only for untreated contacts. The estimated MDR-TB incidence reduction was 90% (9%–99%) using data from 5 comparison studies. We also found high treatment discontinuation rates due to adverse effects in persons taking pyrazinamide-containing regimens. Cost-effectiveness was greatest using a fluoroquinolone/ethambutol combination regimen.
  
  Conclusions
  
  Few studies met inclusion criteria, therefore results should be cautiously interpreted. We found a reduced risk of TB incidence with treatment for MDR-LTBI, suggesting effectiveness in prevention of progression to MDR-TB, and confirmed cost-effectiveness. However, we found that pyrazinamide-containing MDR-LTBI regimens often resulted in treatment discontinuation due to adverse effects.
  
  
• Subjects:
  Antitubercular Agents Article Contacts Cost Cost-Benefit Analysis Disease Progression Drug Resistance, Multiple, Bacterial Ethambutol Fluoroquinolones Humans Latent Tuberculosis Multidrug-resistant Pyrazinamide Treatment Treatment Outcome Tuberculosis Tuberculosis, Multidrug-Resistant

  More +
• Source:
  Clin Infect Dis. 64(12):1670-1677
• Pubmed ID:
  28329197
• Pubmed Central ID:
  PMC5543758
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Volume:
  64
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f5d6533782e7daf2b9df61652380c60118b956db5a765dfebb13ddbce0ff6e52
• Download URL:
  https://stacks.cdc.gov/view/cdc/47333/cdc_47333_DS1.pdf
• File Type:
  [PDF - 193.88 KB ]