Short-course Regimen for Subsequent Treatment of Pulmonary Tuberculosis: A Prospective, Randomized, Controlled Multicenter Clinical Trial in China

• Published in: Clinical therapeutics Vol. 40; no. 3; pp. 440 - 449
• Main Authors: Yan, Liping, Kan, Xiaohong, Zhu, Limei, Xu, Kaijin, Yin, Jianjun, Jie, Li, Li, Yong, Yue, Ji, Cui, Wenyu, Du, Juan, Wang, Lihua, Tan, Shouyong, Jiang, Xiangao, Zeng, Zhong, Xu, Shenghui, Wang, Lin, Chen, Yu, He, Weiguo, Gao, Xusheng, Bai, Dapeng, Zhao, Chengjie, Yan, Xiaofeng, Zhu, Yuyin, Fan, Yumei, Xie, Lanpin, Deng, Aihua, Zhang, Qing, Xiao, Heping
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2018; Elsevier Limited
• Subjects: Acids; Chemotherapy; Clinical outcomes; Clinical trials; Drug dosages; Drug resistance; Ethambutol; Isoniazid; Microscopy; Moxifloxacin; multidrug-resistant tuberculosis; Mycobacterium tuberculosis; Patients; pulmonary tuberculosis; Pyrazinamide; randomized controlled trial; Rifabutin; Rifampin; RNA polymerase; Streptomycin; Systematic review; Tuberculosis; tuberculosis treatment; China; pulmonary tuberculosis; multidrug-resistant tuberculosis; tuberculosis treatment; randomized controlled trial
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2018.01.013

We designed a prospective, multicenter, randomized, controlled study to assess a 5-month regimen compared with the standard regimen on previously treated patients with pulmonary tuberculosis (TB). We enrolled 917 sputum smear–positive patients undergoing additional treatment in 27 major tuberculosis hospitals in China. Patients were randomly assigned to a test group (n = 626)treated with a 5-month regimen of moxifloxacin, pasiniazid, rifabutin, ethambutol, and pyrazinamide or a reference group (n = 291) treated with an 8-month regimen of isoniazid, rifampicin, and streptomycin. All patients with a favorable response were followed up for 5 years after the end of treatment. Of the study patients, 61 in the test group and 19 in the reference group had multidrug-resistant (MDR) TB. The treatment success rate in the study group was 74.12%, which was significantly higher than the 67.70% in the reference group (P = 0.04), whereas the treatment success rate of patients with MDR-TB was not significantly different between the test and reference groups (70.5% vs 63.1%, P =0.79). The adverse effects rates in the test and reference groups were 7.4% and 3.1%, respectively (P = .01). The difference in the TB recurrence rates between the group arm (9.6%) and the reference group (21.8%) was statistically significant (P < 0.001). The moxifloxacin, pasiniazid, rifabutin, ethambutol, and pyrazinamide test regimen yielded higher success and lower recurrence rates than the currently recommended isoniazid, rifampicin, and streptomycin regimen, but the rate of adverse effects was higher. ClinicalTrials.gov identifier: NCT02331823.