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Introducing Molecular Testing of Pyrazinamide Susceptibility Improves MDR-TB Treatment Outcomes: A Prospective Cohort Study.
European Respiratory Journal 2018 December 22
The current treatment for multidrug-resistant tuberculosis (MDR-TB) takes a lengthy period of 18-24 months and has a poor cure rate of 50-60%. A multi-center, prospective cohort study was conducted to assess the role of molecular susceptibility testing to pyrazinamide (PZA) in optimising the treatment for MDR-TB.We assigned 76 patients in the molecular susceptibility optimised group and 159 patients in the regular treatment group where PZA susceptibility was not determined. One hundred and fifty-two patients were matched (76 in the optimised group and 76 in the regular group) after the propensity score matching. The treatment success rate was measured in the propensity-matched cohort as the primary outcome.Patients in the optimised group achieved a higher treatment success rate than the regular group (76.3% v.s. 55.3%, p=0.006). Of 51 patients with isolates that were susceptible to PZA receiving 12-month regimen, 42 (82.4%) were treated successfully. The optimised group showed faster culture conversion than the regular group (p=0.024). After exclusion of pre-XDR TB, the treatment outcome in the optimised group was still better than the regular group (83.1% v.s. 62.1%, p=0.009).Introducing PZA molecular susceptibility testing improved the treatment outcomes of MDR-TB without use of new drugs. In the cohort introducing PZA for patients with PZA susceptible MDR-TB, the current regimen may be shortened to 12 months with comparable success rates to the WHO recommended shorter regimen.
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