Unfavorable treatment outcome of multidrug-resistant tuberculosis in China: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Junping ¹ , SUN Yanbo ² , ZHANG Shulan ² , GUAN Li ³ , LIU Zhixin ¹ , SUN Minglei ¹ , ZHAO Juan ¹ , WANG Chen ¹ , ZOU Dandan ¹ ,  LIANG Libo ^1,4

1. School of Health Management, Harbin Medical University, Harbin 150081, P.R.China;
2. Heilongjiang Provincial Center for Disease Control and Prevention, Harbin 150030, P.R.China;
3. Infectious Disease Hospital of Heilongjiang Province, Harbin 150500, P.R.China;
4. National Health Social Risk Prevention and Collaboration Innovation Center, Shanghai 200032, P.R.China;

Corresponding author：

LIANG Libo, Email: llbhit@163.com

Keywords：

Multidrug-resistant tuberculosis; Unfavorable treatment outcome; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202106123

Video：

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Objective To systematically review the unfavorable treatment outcome of multidrug-resistant tuberculosis in China. Methods CNKI, WanFang Data, CBM, PubMed, EMbase, and Web of Science databases were electronically searched to collect studies that reported unfavorable treatment outcomes of multidrug-resistant tuberculosis in China from inception to April 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed by using Stata 12.0 software. Results A total of 11 studies involving 4 465 patients were included. The results of meta-analysis showed that the overall rate of treatment success was 62% (95%CI 55% to 70%), the rate of treatment failure was 19% (95%CI 12% to 26%), the rate of default was 7% (95%CI 4% to 10%), the rate of mortality was 6% (95%CI 4% to 8%) and the rate of unfavorable treatment outcome was 25% (95%CI 19% to 32%). Conclusions Current evidence shows that the treatment failure rate of multidrug-resistant tuberculosis in China is slightly high. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Citation： LIU Junping, SUN Yanbo, ZHANG Shulan, GUAN Li, LIU Zhixin, SUN Minglei, ZHAO Juan, WANG Chen, ZOU Dandan, LIANG Libo. Unfavorable treatment outcome of multidrug-resistant tuberculosis in China: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(10): 1174-1178. doi: 10.7507/1672-2531.202106123 Copy

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2.	Lange C, Aarnoutse RE, Alffenaar JWC, et al. Management of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis, 2019, 23(6): 645-662.
3.	Khan I, Ahmad N, Khan S, et al. Evaluation of treatment outcomes and factors associated with unsuccessful outcomes in multidrug resistant tuberculosis patients in Baluchistan province of Pakistan. J Infect Public Health, 2019, 12(6): 809-815.
4.	Johnston JC, Shahidi NC, Sadatsafavi M, et al. Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis. PLoS One, 2009, 4(9): e6914.
5.	Orenstein EW, Basu S, Shah NS, et al. Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. Lancet Infect Dis, 2009, 9(3): 153-161.
6.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7.	曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
8.	王丹, 翟俊霞, 牟振云, 等. Meta 分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
9.	Tang S, Tan S, Yao L, et al. Risk factors for poor treatment outcomes in patients with MDR-TB and XDR-TB in China: retrospective multi-center investigation. PLoS One, 2013, 8(12): e82943.
10.	Li Q, Shi CX, Lu M, et al. Treatment outcomes of multidrug-resistant tuberculosis in Hangzhou, China, 2011 to 2015. Medicine (Baltimore), 2020, 99(30): e21296.
11.	Zhang Q, Wu Z, Zhang Z, et al. Efficacy and effect of free treatment on multidrug-resistant tuberculosis. Exp Ther Med, 2016, 11(3): 777-782.
12.	Alene KA, Yi H, Viney K, et al. Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC Infect Dis, 2017, 17(1): 573.
13.	Zhang L, Meng Q, Chen S, et al. Treatment outcomes of multidrug-resistant tuberculosis patients in Zhejiang, China, 2009-2013. Clin Microbiol Infect, 2018, 24(4): 381-388.
14.	Yu MC, Chiang CY, Lee JJ, et al. Treatment outcomes of multidrug-resistant tuberculosis in taiwan: tackling loss to follow-up. Clin Infect Dis, 2018, 67(2): 202-210.
15.	王丹吉, 卢鹏, 刘巧, 等. 耐多药肺结核患者治疗转归的影响因素分析. 结核病与肺部健康杂志, 2017, 6(3): 254-259.
16.	张玲. 耐多药肺结核治疗及其影响因素分析. 临床肺科杂志, 2016, 21(8): 1508-1511.
17.	吕德良, 谭卫国, 张乐平, 等. 影响深圳市耐多药结核病患者治愈的相关因素的双向性队列研究. 临床肺科杂志, 2017, 22(7): 1165-1168.
18.	丁晓艳, 刘巧, 孔雯, 等. 2009-2013 年江苏省耐多药患者治疗转归及影响因素分析. 结核病与肺部健康杂志, 2016, (4): 271-276.
19.	周正华, 梁志勇, 邓小懂. 清远市耐多药肺结核患者治疗效果及其影响因素分析. 吉林医学, 2020, 41(3): 648-650.
20.	Collaborative group for the meta-analysis of individual patient data in MDR-TB treatment-2017, Ahmad N, Ahuja SD, et al. Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet, 2018, 392(10150): 821-834.
21.	沈胜伟. DOT 管理模式在肺结核疾病控制中的应用. 中医药管理杂志, 2014, 22(2): 244-245.
22.	Park SK, Lee WC, Lee DH, et al. Self-administered, standardized regimens for multidrug-resistant tuberculosis in South Korea. Int J Tuberc Lung Dis, 2004, 8(3): 361-368.
23.	屠德华. 肺结核化学治疗中标准化方案与个体化方案的应用. 中华结核和呼吸杂志, 2004, 27(2): 75-76.
24.	杜建, 徐彩红, 李琦, 等. 不同类型治疗方案治疗耐多药结核病效果文献分析. 中国防痨杂志, 2010, 32(8): 421-426.
25.	李春华, 赵攀, 吕圣秀, 等. 127 例耐多药肺结核 CT 影像学改变与临床. 重庆医学, 2014, (23): 3078-3080.
26.	Keshavjee S, Gelmanova IY, Farmer PE, et al. Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study. Lancet, 2008, 372(9647): 1403-1409.
27.	Dheda K, Shean K, Zumla A, et al. Early treatment outcomes and HIV status of patients with extensively drug-resistant tuberculosis in South Africa: a retrospective cohort study. Lancet, 2010, 375(9728): 1798-1807.
28.	吴兰香. 耐多药结核病人影响因素病例对照研究. 中国公共卫生, 2011, 27(4): 401-402.
29.	郭红革, 陈伟, 赵文钧. 珠海市 2015-2017 年结核病耐药状况分析. 华南预防医学, 2018, 44(3): 258-260.

1. Daniel TM. The history of tuberculosis. Respir Med, 2006, 100(11): 1862-1870.
2. Lange C, Aarnoutse RE, Alffenaar JWC, et al. Management of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis, 2019, 23(6): 645-662.
3. Khan I, Ahmad N, Khan S, et al. Evaluation of treatment outcomes and factors associated with unsuccessful outcomes in multidrug resistant tuberculosis patients in Baluchistan province of Pakistan. J Infect Public Health, 2019, 12(6): 809-815.
4. Johnston JC, Shahidi NC, Sadatsafavi M, et al. Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis. PLoS One, 2009, 4(9): e6914.
5. Orenstein EW, Basu S, Shah NS, et al. Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. Lancet Infect Dis, 2009, 9(3): 153-161.
6. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7. 曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
8. 王丹, 翟俊霞, 牟振云, 等. Meta 分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
9. Tang S, Tan S, Yao L, et al. Risk factors for poor treatment outcomes in patients with MDR-TB and XDR-TB in China: retrospective multi-center investigation. PLoS One, 2013, 8(12): e82943.
10. Li Q, Shi CX, Lu M, et al. Treatment outcomes of multidrug-resistant tuberculosis in Hangzhou, China, 2011 to 2015. Medicine (Baltimore), 2020, 99(30): e21296.
11. Zhang Q, Wu Z, Zhang Z, et al. Efficacy and effect of free treatment on multidrug-resistant tuberculosis. Exp Ther Med, 2016, 11(3): 777-782.
12. Alene KA, Yi H, Viney K, et al. Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC Infect Dis, 2017, 17(1): 573.
13. Zhang L, Meng Q, Chen S, et al. Treatment outcomes of multidrug-resistant tuberculosis patients in Zhejiang, China, 2009-2013. Clin Microbiol Infect, 2018, 24(4): 381-388.
14. Yu MC, Chiang CY, Lee JJ, et al. Treatment outcomes of multidrug-resistant tuberculosis in taiwan: tackling loss to follow-up. Clin Infect Dis, 2018, 67(2): 202-210.
15. 王丹吉, 卢鹏, 刘巧, 等. 耐多药肺结核患者治疗转归的影响因素分析. 结核病与肺部健康杂志, 2017, 6(3): 254-259.
16. 张玲. 耐多药肺结核治疗及其影响因素分析. 临床肺科杂志, 2016, 21(8): 1508-1511.
17. 吕德良, 谭卫国, 张乐平, 等. 影响深圳市耐多药结核病患者治愈的相关因素的双向性队列研究. 临床肺科杂志, 2017, 22(7): 1165-1168.
18. 丁晓艳, 刘巧, 孔雯, 等. 2009-2013 年江苏省耐多药患者治疗转归及影响因素分析. 结核病与肺部健康杂志, 2016, (4): 271-276.
19. 周正华, 梁志勇, 邓小懂. 清远市耐多药肺结核患者治疗效果及其影响因素分析. 吉林医学, 2020, 41(3): 648-650.
20. Collaborative group for the meta-analysis of individual patient data in MDR-TB treatment-2017, Ahmad N, Ahuja SD, et al. Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet, 2018, 392(10150): 821-834.
21. 沈胜伟. DOT 管理模式在肺结核疾病控制中的应用. 中医药管理杂志, 2014, 22(2): 244-245.
22. Park SK, Lee WC, Lee DH, et al. Self-administered, standardized regimens for multidrug-resistant tuberculosis in South Korea. Int J Tuberc Lung Dis, 2004, 8(3): 361-368.
23. 屠德华. 肺结核化学治疗中标准化方案与个体化方案的应用. 中华结核和呼吸杂志, 2004, 27(2): 75-76.
24. 杜建, 徐彩红, 李琦, 等. 不同类型治疗方案治疗耐多药结核病效果文献分析. 中国防痨杂志, 2010, 32(8): 421-426.
25. 李春华, 赵攀, 吕圣秀, 等. 127 例耐多药肺结核 CT 影像学改变与临床. 重庆医学, 2014, (23): 3078-3080.
26. Keshavjee S, Gelmanova IY, Farmer PE, et al. Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study. Lancet, 2008, 372(9647): 1403-1409.
27. Dheda K, Shean K, Zumla A, et al. Early treatment outcomes and HIV status of patients with extensively drug-resistant tuberculosis in South Africa: a retrospective cohort study. Lancet, 2010, 375(9728): 1798-1807.
28. 吴兰香. 耐多药结核病人影响因素病例对照研究. 中国公共卫生, 2011, 27(4): 401-402.
29. 郭红革, 陈伟, 赵文钧. 珠海市 2015-2017 年结核病耐药状况分析. 华南预防医学, 2018, 44(3): 258-260.

Chinese Journal of Evidence-Based Medicine

Unfavorable treatment outcome of multidrug-resistant tuberculosis in China: a meta-analysis

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