Clinical Management of Multidrug‐Resistant Tuberculosis in 16 European Countries

Journal article

G. Günther, F. van Leth, S. Alexandru, N. Altet, K. Avsar, D. Bang, R. Barbuta, G. Bothamley, A. Ciobanu, V. Crudu, M. Danilovitš, M. Dedicoat, R. Duarte, G. Gualano, H. Kunst, W. D. de Lange, V. Leimane, A. McLaughlin, C. Magis-Escurra, I. Muylle, V. Polcová, C. Popa, R. Rumetshofer, A. Skrahina, V. Solodovnikova, V. Spînu, Simon Tiberi, P. Viiklepp, C. Lange
American Journal of Respiratory and Critical Care Medicine, 2018

Semantic Scholar DOI PubMed

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APA Click to copy
Günther, G., van Leth, F., Alexandru, S., Altet, N., Avsar, K., Bang, D., … Lange, C. (2018). Clinical Management of Multidrug‐Resistant Tuberculosis in 16 European Countries. American Journal of Respiratory and Critical Care Medicine.

Chicago/Turabian Click to copy
Günther, G., F. van Leth, S. Alexandru, N. Altet, K. Avsar, D. Bang, R. Barbuta, et al. “Clinical Management of Multidrug‐Resistant Tuberculosis in 16 European Countries.” American Journal of Respiratory and Critical Care Medicine (2018).

MLA Click to copy
Günther, G., et al. “Clinical Management of Multidrug‐Resistant Tuberculosis in 16 European Countries.” American Journal of Respiratory and Critical Care Medicine, 2018.

BibTeX Click to copy

@article{g2018a,
  title = {Clinical Management of Multidrug‐Resistant Tuberculosis in 16 European Countries},
  year = {2018},
  journal = {American Journal of Respiratory and Critical Care Medicine},
  author = {Günther, G. and van Leth, F. and Alexandru, S. and Altet, N. and Avsar, K. and Bang, D. and Barbuta, R. and Bothamley, G. and Ciobanu, A. and Crudu, V. and Danilovitš, M. and Dedicoat, M. and Duarte, R. and Gualano, G. and Kunst, H. and de Lange, W. D. and Leimane, V. and McLaughlin, A. and Magis-Escurra, C. and Muylle, I. and Polcová, V. and Popa, C. and Rumetshofer, R. and Skrahina, A. and Solodovnikova, V. and Spînu, V. and Tiberi, Simon and Viiklepp, P. and Lange, C.}
}

Abstract

&NA; Rationale: Multidrug‐resistant tuberculosis (MDR‐TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. Objectives: To document the management and treatment outcome in patients with MDR‐TB in Europe. Methods: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR‐TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). Measurements and Main Results: A total of 380 patients with MDR‐TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high‐incidence countries compared with low‐incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high‐incidence countries. Simplified outcome definitions that include 1 year of follow‐up after the end of treatment showed similar frequency of relapse‐free cure in low‐ (58.3%), intermediate‐ (55.8%), and high‐incidence (57.1%) countries, but highest frequency of failure in high‐incidence countries (24.1% vs. 14.6%). Conclusions: Conventional standard MDR‐TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR‐TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.