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Directly observed therapy for MDR-TB associated with reduced mortality
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CDC researchers reported at the 2017 American Thoracic Society International Conference that directly observed therapy for multidrug-resistant tuberculosis was associated with a 77% reduction in all-cause mortality risk over a 20-year period compared with self-administered therapy in the United States.
“Directly observed therapy (DOT) is already recommended to treat all forms of TB, but it’s valuable to have this data on the effectiveness among patients with [multidrug-resistant (MDR)] TB,” Jorge Salinas, MD, lead study author and Epidemic Intelligence Service officer in the CDC’s Division of Tuberculosis Elimination, said in a press release. “We wanted to assess whether the strategy influenced mortality in MDR-TB patients.”
Salinas and colleagues examined data from 3,434 patients who were treated for MDR-TB in the U.S. from 1993 to 2013. The results were adjusted for age, gender, race/ethnicity, HIV infection, prior TB disease, site of disease and additional resistance to other drugs such as fluoroquinolones or a second-line injectable drug. Study models were stratified by patients’ origin and period of treatment.
According to the data, 21% (n = 709) of patients died while receiving TB treatment. Most patients were non-U.S. born and of Asian (50%) or Hispanic (33%) race/ethnicity. Of those with available data, 34% had HIV, 18% had previous TB infection and 17% had additional drug resistance.
The use of DOT increased from 74% during 1993 to 2002 to 95% during 2002 to 2013, and correlated with a decrease in all-cause mortality from 31% to 11% during these periods.
Risk factors for all-cause mortality included older age (adjusted HR = 1.15; 95% CI, 1.11-1.2) and HIV infection (aHR = 7.11; 95% CI, 5.46-9.24). In all stratified models, DOT was protective against all-cause mortality (aHR = 0.23; 95% CI, 0.19-0.28).
“This protective effect may come from DOT alone or from other patient-centered measures, such as transportation assistance or food stamps given along with DOT by TB treatment facilities to improve treatment adherence,” Salinas said in the release. “The findings reinforce that all patients with MDR-TB should receive DOT and other patient-centered measures to ensure patients complete their treatment.”
Reference:
Salinas JL, et al. Abstract 5304. Presented at: American Thoracic Society International Conference; May 19-24, 2017; Washington, D.C.
Disclosure: Salinas reports no relevant financial disclosures.