Impacts of clofazimine on the treatment outcomes of drug-resistant tuberculosis

• Published in: Microbes and infection Vol. 25; no. 1-2; p. 105020
• Main Authors: Wang, Ming-Gui, Liu, Xiang-Min, Wu, Shou-Quan, He, Jian-Qing
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.01.2023
• Subjects: Antitubercular Agents - therapeutic use; Clofazimine; Clofazimine - therapeutic use; Extensively drug resistant; Extensively Drug-Resistant Tuberculosis - drug therapy; Humans; Multidrug resistance; Treatment Outcome; Tuberculosis, Multidrug-Resistant - drug therapy; Extensively drug resistant; Multidrug resistance; Clofazimine
• ISSN: 1286-4579; 1769-714X
• DOI: 10.1016/j.micinf.2022.105020

The purpose of this research was to evaluate the effect of clofazimine on drug-resistant tuberculosis treatment outcomes. A systematic search was conducted in the PubMed, Web of Science and EMBASE databases to identify eligible studies published up to July 10, 2021. The search terms were as follows: “clofazimine,” “tuberculosis,” “multidrug resistant tuberculosis” or “extensively drug resistant tuberculosis” and their synonyms or similar words. Two researchers independently screened the titles, abstracts, and full texts for inclusion. Meta-analysis was performed with Stata version 16.0 (Stata Corp., College Station, Texas, USA). Risk ratios (RRs) with 95% CIs were calculated to evaluate the treatment outcome. Eight studies including 3219 participants were included in the meta-analysis. The meta-analysis found that the rates of treatment completion was higher in patients receiving clofazimine-containing regimens than in those not receiving clofazimine-containing regimens (RR: 1.185 (1.060–1.325), P = 0.003). Significant reduction in treatment failure (RR: 0.598 (0.473–0.756), P < 0.001) was found in the clofazimine treatment group. The subgroup analyses of randomized controlled trials (RCTs) found a higher rates of favorable outcomes, treatment completion and cure in the clofazimine group than in the control group (RR: 1.203 (1.029–1.407), P = 0.020; RR: 3.167 (2.043–4.908), P < 0.001; and RR: 1.251 (1.031–1.518), P = 0.023, respectively). Patients receiving clofazimine had a lower risk of treatment failure than those not receiving clofazimine (RR: 0.529 (0.454–0.616), P < 0.001). However, clofazimine treatment did not have a statistically significant effect on all-cause mortality in RCTs. This study demonstrated that compared with patients who do not receive clofazimine, this drug has the potential to achieve a higher favorable outcome, treatment completion and cure rates, and a lower treatment failure risk among drug-resistant tuberculosis cases.