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WASHINGTON -- Among patients in the U.S. with multidrug resistant tuberculosis, (DOT) was associated with a 77% decrease in mortality compared with self-administered treatment, researchers reported herein a CDC
An examination of surveillance data for cases of multidrug-resistant tuberculosis (MDR-TB) reported to the CDC from 1993 to 2013 showed that DOT increased from 74% during 1993-2002 to 95% during 2002-2013, while all-cause mortality decreased from 31% to 11% during these periods, reported Jorge Salinas, MD, of the CDC division of tuberculosis elimination in Atlanta, and colleagues.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The analysis confirmed that DOT is an effective strategy for reducing deaths from MDR-TB in the U.S., the authors stated in a presentation at the American Thoracic Society meeting.
"Directly observed therapy is already recommended to treat all forms of TB, but it's valuable to have this data on the effectiveness among patients with MDR-TB," Salinas noted in a written press statement.
A total of were reported to the CDC in 2016 (provisional data), which represents a 2.7% decrease in cases from the previous year and the lowest annual TB burden on record in the country.
suggested that the percentage of MDR-TB cases in the U.S. declined slightly from 1.3% of all new cases in 2014 to 1.2%.
The CDC reported that proportion of TB patients prescribed the recommended initial treatment regimen including isoniazid, rifampin, pyrazinamide, and ethambutol increased from 40.3% in 1993 to 84.7% in 2015. The proportion of eligible TB patients who completed treatment within 1 year increased from 63.4% in 1993 to 89.6% in 2013 (the latest year that data is available).
A total of 3,434 MDR-TB patients, including 709 who died during follow-up, were included in the analysis. HIV co-infection was present in 34%, while 18% had a prior diagnosis of TB, and 17% had an additional drug resistance. The vast majority (88%) were born in either Asian or Hispanic countries.
The investigators used Cox proportional hazards models to estimate adjusted hazard ratios (aHR) and 95% confidence intervals for the association of treatment administration mode (DOT versus self-administered therapy) with all-cause mortality during TB treatment, accounting for age (per 5- year increments), sex, race/ethnicity, HIV infection, previous TB disease, site of disease (i.e., pulmonary versus extrapulmonary), and additional drug resistance (i.e., resistance to at least one fluoroquinolone or a second-line injectable drug).
Stratified models were also fit for place of origin (U.S.-born or foreign-born) and period of treatment (1993-2002 or 2003-2013). Half the patients (50%) were Asian and a third (33%) were Hispanic.
Older age (aHR 1.15, 95% CI 1.11-1.20) and reported HIV infection (aHR 7.11, 95% CI 5.46-9.24) were risk factors for all-cause mortality irrespective of patient's origin or period of treatment.
Receiving DOT (aHR 0.23, 95% CI, 0.19-0.28) was protective in all stratified models.
"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.
"A continued emphasis on maximizing DOT coverage can help reduce all-cause mortality," the authors concluded.
Primary Source
American Thoracic Society
Salinas JL, et al "Factors Associated with Mortality Among Patients with Multidrug-Resistant Tuberculosis-United States, 1993-2013" ATS 2017; Abstract 5304.