Intermittent versus daily pulmonary tuberculosis treatment regimens: A meta-analysis

Samuel Kasozi, Justin Clark, Suhail A R Doi

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)

Abstract

BACKGROUND: Several systematic reviews suggest that intermittent pulmonary tuberculosis (TB) chemotherapy is effective, but intensity (daily versus intermittent) and duration of rifampicin use (intensive phase only versus both phases) have not been distinguished. In addition, the various outcomes (success, failure, relapse, and default) have only selectively been evaluated.

METHODS: We conducted a meta-analysis of proportions using all four outcomes as multi-category proportions to examine the effectiveness of WHO category 1 TB treatment regimens. Database searches of studies reporting treatment outcomes of HIV negative subjects were included and stratified by intensity of therapy and duration of rifampicin therapy. Using a bias-adjusted statistical model, we pooled proportions of the four treatment outcome categories using a method that handles multi-category proportions.

RESULTS: A total of 27 studies comprising of 48 data sets with 10,624 participants were studied. Overall, treatment success was similar among patients treated with intermittent (I/I) (88%) (95% CI, 81-92) and daily (D/D) (90%) (95% CI, 84-95) regimens. Default was significantly less with I/I (0%) (95% CI, 0-2) compared to D/D regimens (5%) (95% CI, 1-9). Nevertheless, I/I relapse rates (7%) (95% CI, 3-11) were higher than D/D relapse rates (1%) (95% CI, 0-3).

CONCLUSION: Treatment regimens that are offered completely intermittently versus completely daily are associated with a trade-off between treatment relapse and treatment default. There is a possibility that I/I regimens can be improved by increasing treatment duration, and this needs to be urgently addressed by future studies.

Original languageEnglish
Pages (from-to)117-138
Number of pages22
JournalClinical Medicine and Research
Volume13
Issue number3-4
DOIs
Publication statusPublished - Dec 2015
Externally publishedYes

Fingerprint

Pulmonary Tuberculosis
Meta-Analysis
Recurrence
Therapeutics
Rifampin
Statistical Models
Tuberculosis
HIV
Databases
Drug Therapy

Cite this

Kasozi, Samuel ; Clark, Justin ; Doi, Suhail A R. / Intermittent versus daily pulmonary tuberculosis treatment regimens : A meta-analysis. In: Clinical Medicine and Research. 2015 ; Vol. 13, No. 3-4. pp. 117-138.
@article{4e04e815f6ba4108853e2f951e4c3e1b,
title = "Intermittent versus daily pulmonary tuberculosis treatment regimens: A meta-analysis",
abstract = "BACKGROUND: Several systematic reviews suggest that intermittent pulmonary tuberculosis (TB) chemotherapy is effective, but intensity (daily versus intermittent) and duration of rifampicin use (intensive phase only versus both phases) have not been distinguished. In addition, the various outcomes (success, failure, relapse, and default) have only selectively been evaluated.METHODS: We conducted a meta-analysis of proportions using all four outcomes as multi-category proportions to examine the effectiveness of WHO category 1 TB treatment regimens. Database searches of studies reporting treatment outcomes of HIV negative subjects were included and stratified by intensity of therapy and duration of rifampicin therapy. Using a bias-adjusted statistical model, we pooled proportions of the four treatment outcome categories using a method that handles multi-category proportions.RESULTS: A total of 27 studies comprising of 48 data sets with 10,624 participants were studied. Overall, treatment success was similar among patients treated with intermittent (I/I) (88{\%}) (95{\%} CI, 81-92) and daily (D/D) (90{\%}) (95{\%} CI, 84-95) regimens. Default was significantly less with I/I (0{\%}) (95{\%} CI, 0-2) compared to D/D regimens (5{\%}) (95{\%} CI, 1-9). Nevertheless, I/I relapse rates (7{\%}) (95{\%} CI, 3-11) were higher than D/D relapse rates (1{\%}) (95{\%} CI, 0-3).CONCLUSION: Treatment regimens that are offered completely intermittently versus completely daily are associated with a trade-off between treatment relapse and treatment default. There is a possibility that I/I regimens can be improved by increasing treatment duration, and this needs to be urgently addressed by future studies.",
author = "Samuel Kasozi and Justin Clark and Doi, {Suhail A R}",
note = "{\circledC} 2015 Marshfield Clinic.",
year = "2015",
month = "12",
doi = "10.3121/cmr.2015.1272",
language = "English",
volume = "13",
pages = "117--138",
journal = "Clinical Medicine and Research",
issn = "1539-4182",
publisher = "Marshfield Clinic",
number = "3-4",

}

Intermittent versus daily pulmonary tuberculosis treatment regimens : A meta-analysis. / Kasozi, Samuel; Clark, Justin; Doi, Suhail A R.

In: Clinical Medicine and Research, Vol. 13, No. 3-4, 12.2015, p. 117-138.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Intermittent versus daily pulmonary tuberculosis treatment regimens

T2 - A meta-analysis

AU - Kasozi, Samuel

AU - Clark, Justin

AU - Doi, Suhail A R

N1 - © 2015 Marshfield Clinic.

PY - 2015/12

Y1 - 2015/12

N2 - BACKGROUND: Several systematic reviews suggest that intermittent pulmonary tuberculosis (TB) chemotherapy is effective, but intensity (daily versus intermittent) and duration of rifampicin use (intensive phase only versus both phases) have not been distinguished. In addition, the various outcomes (success, failure, relapse, and default) have only selectively been evaluated.METHODS: We conducted a meta-analysis of proportions using all four outcomes as multi-category proportions to examine the effectiveness of WHO category 1 TB treatment regimens. Database searches of studies reporting treatment outcomes of HIV negative subjects were included and stratified by intensity of therapy and duration of rifampicin therapy. Using a bias-adjusted statistical model, we pooled proportions of the four treatment outcome categories using a method that handles multi-category proportions.RESULTS: A total of 27 studies comprising of 48 data sets with 10,624 participants were studied. Overall, treatment success was similar among patients treated with intermittent (I/I) (88%) (95% CI, 81-92) and daily (D/D) (90%) (95% CI, 84-95) regimens. Default was significantly less with I/I (0%) (95% CI, 0-2) compared to D/D regimens (5%) (95% CI, 1-9). Nevertheless, I/I relapse rates (7%) (95% CI, 3-11) were higher than D/D relapse rates (1%) (95% CI, 0-3).CONCLUSION: Treatment regimens that are offered completely intermittently versus completely daily are associated with a trade-off between treatment relapse and treatment default. There is a possibility that I/I regimens can be improved by increasing treatment duration, and this needs to be urgently addressed by future studies.

AB - BACKGROUND: Several systematic reviews suggest that intermittent pulmonary tuberculosis (TB) chemotherapy is effective, but intensity (daily versus intermittent) and duration of rifampicin use (intensive phase only versus both phases) have not been distinguished. In addition, the various outcomes (success, failure, relapse, and default) have only selectively been evaluated.METHODS: We conducted a meta-analysis of proportions using all four outcomes as multi-category proportions to examine the effectiveness of WHO category 1 TB treatment regimens. Database searches of studies reporting treatment outcomes of HIV negative subjects were included and stratified by intensity of therapy and duration of rifampicin therapy. Using a bias-adjusted statistical model, we pooled proportions of the four treatment outcome categories using a method that handles multi-category proportions.RESULTS: A total of 27 studies comprising of 48 data sets with 10,624 participants were studied. Overall, treatment success was similar among patients treated with intermittent (I/I) (88%) (95% CI, 81-92) and daily (D/D) (90%) (95% CI, 84-95) regimens. Default was significantly less with I/I (0%) (95% CI, 0-2) compared to D/D regimens (5%) (95% CI, 1-9). Nevertheless, I/I relapse rates (7%) (95% CI, 3-11) were higher than D/D relapse rates (1%) (95% CI, 0-3).CONCLUSION: Treatment regimens that are offered completely intermittently versus completely daily are associated with a trade-off between treatment relapse and treatment default. There is a possibility that I/I regimens can be improved by increasing treatment duration, and this needs to be urgently addressed by future studies.

UR - http://www.scopus.com/inward/record.url?scp=84946507310&partnerID=8YFLogxK

U2 - 10.3121/cmr.2015.1272

DO - 10.3121/cmr.2015.1272

M3 - Article

VL - 13

SP - 117

EP - 138

JO - Clinical Medicine and Research

JF - Clinical Medicine and Research

SN - 1539-4182

IS - 3-4

ER -