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Later generation fluoroquinolones may improve outcomes for patients with XDR-TB

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For every additional 10% of patients with extensively drug-resistant tuberculosis receiving fluoroquinolones, there may be a 4% increase in clinical outcomes, according to findings presented at the 47th Annual Meeting of the Infectious Diseases Society of America, held this week in Philadelphia. The results were presented by Karen R. Jacobson, MD, of Massachusetts General Hospital in Boston.

Researchers conducted a retrospective analysis of studies involving XDR-TB treatment outcomes through May 2009. PubMed and EMBASE database searches yielded 13 observational studies involving 571 patients.

“We wanted to look at a number of small published studies, combine the information, and try to get a sense of whether there are patient demographics or interventions that improve treatment outcomes,” Jacobson said.

Overall favorable outcomes were defined as patients who were cured or completed treatment. A 43.7% (95% CI, 32.8%-54.5%) rate of favorable outcomes was observed. There was an estimated 20.8% (95% CI, 14.2%-27.3%) proportion of patients who died.

Later generation fluoroquinolones were defined as levoflxacin, moxifloxacin and sparfloxacin. An association between those medications and favorable outcomes was observed (P=.001). For every 10% of patients receiving these medications, a 4% increase in favorable outcomes was observed.

“It is important to note that though these associations were observed, these drugs were given in combination with other therapies,” Jacobson said.

An association between favorable outcomes and studies with younger patients also was observed (P=.004).

This study may be the first to provide empirical evidence of the benefit of later generation fluoroquinolones for the treatment of XDR-TB and may be the first to report a positive association between any intervention and improved care for these patients.

“This is a summarization of several studies done on the study level and not on an individual patient level,” Jacobson said. “But it is an interesting signal that we are seeing about a potential intervention for a very deadly disease.”