Effect of a modified regimen on drug-sensitive retreated pulmonary tuberculosis: A multicenter study in China

Qiping Ge; Yan Ma; Lijie Zhang; Liping Ma; Caiyan Zhao; Yuhui Chen; Xuerui Huang; Wei Shu; Shengyu Chen; Fei Wang; Bo Li; Xiqin Han; Lian Shi; Xin Wang; Youlun Li; Shangpeng Yang; Wenli Cao; Qianying Liu; Ling Chen; Chao Wu; Bing Ouyang; Furong Wang; Po Li; Xiang Wu; Xiue Xi; Xueyan Leng; Haiqing Zhang; Hua Li; Juan Li; Chengqing Yang; Peng Zhang; Hongzhe Cui; Yuhong Liu; Chengcheng Kong; Zhaogang Sun; Jian Du; Weiwei Gao

doi:10.3389/fpubh.2023.1039399

Effect of a modified regimen on drug-sensitive retreated pulmonary tuberculosis: A multicenter study in China

Front Public Health. 2023 Jan 26:11:1039399. doi: 10.3389/fpubh.2023.1039399. eCollection 2023.

Authors

Qiping Ge¹, Yan Ma^{2

3}, Lijie Zhang^{1

4}, Liping Ma⁵, Caiyan Zhao⁶, Yuhui Chen⁷, Xuerui Huang¹, Wei Shu^{1

4}, Shengyu Chen⁸, Fei Wang⁹, Bo Li¹⁰, Xiqin Han¹, Lian Shi¹¹, Xin Wang¹², Youlun Li¹³, Shangpeng Yang¹⁴, Wenli Cao¹⁵, Qianying Liu¹⁶, Ling Chen¹⁷, Chao Wu¹⁸, Bing Ouyang¹⁹, Furong Wang²⁰, Po Li²¹, Xiang Wu²², Xiue Xi²³, Xueyan Leng²⁴, Haiqing Zhang²⁵, Hua Li²⁶, Juan Li²⁷, Chengqing Yang²⁸, Peng Zhang²⁹, Hongzhe Cui³⁰, Yuhong Liu¹, Chengcheng Kong³¹, Zhaogang Sun³¹, Jian Du¹, Weiwei Gao¹

Affiliations

¹ Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
² Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.
³ Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China.
⁴ Administration Office, Clinical Center on Tuberculosis, China CDC, Beijing, China.
⁵ Department of TB Control, Henan Center for Disease Control and Prevention, Zhengzhou, Henan, China.
⁶ Department of Tuberculosis, Haerbin Chest Hospital, Haerbin, China.
⁷ Department of Outpatients, Center for Tuberculosis Control of Guangdong Province, Guangzhou, Guangdong, China.
⁸ Department of Outpatients, Center for Tuberculosis Control of Tianjin, Tianjin, China.
⁹ Department of TB Control, Zhejiang Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
¹⁰ Department of Outpatients, Beijing Center for Disease Control and Prevention, Beijing, China.
¹¹ Department of Tuberculosis, Shenyang Chest Hospital, Shenyang, Liaoning, China.
¹² Department of TB Control, Heilongjiang Center for Disease Control and Prevention, Haerbin, Heilongjiang, China.
¹³ Department of Tuberculosis, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
¹⁴ Department of Tuberculosis, Jingzhou Hospital for Infectious Diseases, Jingzhou, Hubei, China.
¹⁵ Department of Infectious Disease, Beijing Geriatric Hospital, Beijing, China.
¹⁶ Department of Tuberculosis, 8th Medical Center, PLA General Hospital, Beijing, China.
¹⁷ Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
¹⁸ Department of Tuberculosis, The 3rd People's Hospital of Zhenjiang, Zhenjiang, Jiangsu, China.
¹⁹ Department of Tuberculosis, Kunming 3rd People's Hospital, Kunming, Yunnan, China.
²⁰ Department of Medicine, The 4th Hospital of Inner Mongolia Autonomous Region, Huhehaote, China.
²¹ Department of Tuberculosis, The 3rd Hospital of Baotou, Baotou, China.
²² Department of Tuberculosis, Jingmen Center for Disease Control and Prevention, Jingmen, Hubei, China.
²³ Department of Tuberculosis, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China.
²⁴ Department of Tuberculosis, The 3rd Hospital of Qinhuangdao, Qinhuangdao, Hebei, China.
²⁵ Department of Tuberculosis, Xuzhou Hospital for Infectious Diseases, Xuzhou, Jiangsu, China.
²⁶ Department of Tuberculosis, Linfen 3rd People's Hospital, Linfen, Shanxi, China.
²⁷ Department of TB Control, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nangning, China.
²⁸ Department of Respiratory and Critical Care Medicine of Wuhan Tuberculosis Institute, Wuhan, Hubei, China.
²⁹ Department of Tuberculosis, 4th Hospital of Tangshan City, Tangshan, Hebei, China.
³⁰ Department of Tuberculosis Control, Yanbian Institute of Tuberculosis Prevention and Control, Yanbian, Jilin, China.
³¹ Translational Medicine Center, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.

Abstract

Background and objective: Retreatment pulmonary tuberculosis (PTB) still accounts for a large proportion of tuberculosis, and the treatment outcome is unfavorable. The recurrence of retreatment PTB based on long-term follow-up has not been well demonstrated. This study aimed to evaluate effect of a modified regimen on drug-sensitive retreated pulmonary tuberculosis.

Methods: This multicenter cohort study was conducted in 29 hospitals from 23 regions of China from July 1, 2009, to December 31, 2020. Patients were divided into two treatment regimen groups including experimental group [modified regimen (4H-Rt2-E-Z-S(Lfx)/4H-Rt2-E)]and control group [standard regimen (2H-R-E-Z-S/6H-R-E or 3H-R-E-Z/6H-R-E)]. The patients enrolled were followed up of 56 months after successful treatment. We compared the treatment success rate, treatment failure rate, adverse reaction rate, and recurrence rate between two regimens. Multivariate Cox regression model was used to identify the potential risk factors for recurrence after successful treatment with proportional hazards assumptions tested for all variables.

Results: A total of 381 patients with retreatment PTB were enrolled, including 244 (64.0%) in the experimental group and 137 (36.0%) in the control group. Overall, the treatment success rate was significant higher in the experimental group than control group (84.0 vs. 74.5%, P = 0.024); no difference was observed in adverse reactions between the two groups (25.8 vs. 21.2%, P > 0.05). A total of 307 patients completed the 56 months of follow-up, including 205 with the modified regimen and 102 with the standard regimen. Among these, 10 cases (3.3%) relapsed, including 3 in the experimental group and 7 in the control group (1.5% vs 6.9%, P = 0.035). Reduced risks of recurrence were observed in patients treated with the modified regimen compared with the standard regimen, and the adjusted hazard ratio was 0.19 (0.04-0.77).

Conclusion: The modified retreatment regimen had more favorable treatment effects, including higher treatment success rate and lower recurrence rate in patients with retreated drug-sensitive PTB.

Keywords: follow-up; modified regimen; pulmonary tuberculosis; recurrence; retreatment.

Copyright © 2023 Ge, Ma, Zhang, Ma, Zhao, Chen, Huang, Shu, Chen, Wang, Li, Han, Shi, Wang, Li, Yang, Cao, Liu, Chen, Wu, Ouyang, Wang, Li, Wu, Xi, Leng, Zhang, Li, Li, Yang, Zhang, Cui, Liu, Kong, Sun, Du and Gao.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Antitubercular Agents* / therapeutic use
China
Cohort Studies
Humans
Treatment Outcome
Tuberculosis, Pulmonary* / drug therapy

Substances

Antitubercular Agents

Associated data

ChiCTR/ChiCTR1800017441

Grants and funding

This study was supported by the National Science and Technology Major Project of China (2008ZX10003-015-2, 2013ZX10003009-001-007, and 2018ZX10722302-003).