Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Impact of Anti-Tuberculosis Drug Use on Treatment Outcomes in Patients with Pulmonary Fluoroquinolone-Resistant Multidrug-Resistant Tuberculosis: A Nationwide Retrospective Cohort Study with Propensity Score Matching

  • Hongjo Choi (Department of Preventive Medicine, Konyang University College of Medicine) ;
  • Dawoon Jeong (Research and Development Center, The Korean Institute of Tuberculosis, Korean National Tuberculosis Association) ;
  • Young Ae Kang (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Doosoo Jeon (Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Hee-Yeon Kang (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Hee Jin Kim (Central Training Institute, Korean National Tuberculosis Association) ;
  • Hee-Sun Kim (Department of Health Policy Research, National Evidence-based Healthcare Collaborating Agency) ;
  • Jeongha Mok (Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2023.03.28
  • Accepted : 2023.05.26
  • Published : 2023.07.31
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Abstract

Background: Effective treatment of fluoroquinolone-resistant multidrug-resistant tuberculosis (FQr-MDR-TB) is difficult because of the limited number of available core anti-TB drugs and high rates of resistance to anti-TB drugs other than FQs. However, few studies have examined anti-TB drugs that are effective in treating patients with FQr-MDR-TB in a real-world setting. Methods: The impact of anti-TB drug use on treatment outcomes in patients with pulmonary FQr-MDR-TB was retrospectively evaluated using a nationwide integrated TB database (Korean Tuberculosis and Post-Tuberculosis). Data from 2011 to 2017 were included. Results: The study population consisted of 1,082 patients with FQr-MDR-TB. The overall treatment outcomes were as follows: treatment success (69.7%), death (13.7%), lost to follow-up or not evaluated (12.8%), and treatment failure (3.9%). On a propensity-score-matched multivariate logistic regression analysis, the use of bedaquiline (BDQ), linezolid (LZD), levofloxacin (LFX), cycloserine (CS), ethambutol (EMB), pyrazinamide, kanamycin (KM), prothionamide (PTO), and para-aminosalicylic acid against susceptible strains increased the treatment success rate (vs. unfavorable outcomes). The use of LFX, CS, EMB, and PTO against susceptible strains decreased the mortality (vs. treatment success). Conclusion: A therapeutic regimen guided by drug-susceptibility testing can improve the treatment of patients with pulmonary FQr-MDR-TB. In addition to core anti-TB drugs, such as BDQ and LZD, treatment of susceptible strains with later-generation FQs and KM may be beneficial for FQr-MDR-TB patients with limited treatment options.

Keywords

Acknowledgement

This study used the National Health Information Database (NHIS-2019-1-662) of the National Health Insurance Service (NHIS).

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