Majority of patients with TB eligible for shortened therapy continued a prolonged course
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Many patients with tuberculosis who were potentially eligible for a shorter 4-month therapy were treated with standard 6-month courses, according to a recent study.
“Since 2003, the American Thoracic Society, the CDC, and the Infectious Disease Society of America have recommended a shortened 4-month treatment regimen for some people with tuberculosis (TB),” Clarisse Tsang, MPH, told Healio. “Previous studies focused on efficacy of the shorter regimen, but we wanted to understand the characteristics of those diagnosed with TB who could benefit from the shorter regimen but were not on the shortened regimen.”
To assess the proportion of patients receiving shorter therapy, Tsang and colleagues used U.S. National Tuberculosis Surveillance System data to characterize factors associated with 4-month therapy among adult patients who had completed treatment and were eligible. According to Tsang, was done to refine efforts to increase awareness of the 4-month regimen among health care providers.
Between 2011 and 2018, 63,393 patients completed TB treatment, of whom 5,560 (8.8%) were potentially eligible for 4-month therapy. Of these eligible patients, 79% received therapy for longer than 4 months, with the average course of treatment being 6 months.
According to Tsang, the study showed that people receiving the shortened treatment regimen were more likely to be treated by health departments versus by private providers (adjusted RR = 0.94; 95%CI, 0.91–0.98), in the South and West regions of the U.S. (aRR = 0.88; 95% CI, 0.84–0.92 and aRR = 0.92; 95% CI, 0.88–0.96, respectively), nonU.S.-born (aRR = 0.95; 95% CI, 0.91–0.99), and between 25 and 64 years versus the younger range of the recommendation (15 to 24 years).
Additionally, the factors associated with longer treatment, including people having cavitary disease (aRR = 1.10; 95% CI, 1.07–1.14) or being incarcerated with a recent history of experiencing homelessness (aRR = 1.21; 95% CI, 1.06–1.39).
“This study offers insight into real-world implementation of guideline-recommended shorter regimens for people with TB disease, and can help guide clinicians, public health officials, and patients to understand treatment durations may not happen as short as intended,” Tsang said. “Overall, shortened regimens could improve the quality of life for people with TB disease, so understanding who is currently missing out on this advancement and why may better target efforts to reduce barriers and optimize outcomes for both patients and public health.”
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