title: Mycobacterium w Immunotherapy for Treating Pulmonary Tuberculosis - a Systematic Review.
abstract: BACKGROUND
  Tuberculosis (TB) remains a global health catastrophe. Mycobacterium w is a heat-killed immune-modulating vaccine designed to attenuate the effects of TB, reduce time to sputum conversion, and thereby decrease transmission and improve cure rates.
  
  
  OBJECTIVE
  To evaluate Mycobacterium w (M w) immunotherapy as an adjunct to chemotherapy in participants with pulmonary TB (PTB).
  
  
  METHODS
  In January 2012, we performed both a database search, a handsearch and corresponded with experts in the field.
  
  
  METHODS
  Randomised and quasi-randomised controlled trials of M w immunotherapy versus placebo (or no control) for participants with PTB.
  
  
  METHODS
  Two of the authors (SP and ZK) independently extracted data. Dichotomous outcomes were analysed using risk ratios (RR) and 95% confidence intervals (CI).
  
  
  RESULTS
  The primary outcome was to determine the effect of M w therapy on sputum conversion. Secondary outcomes were to determine the frequency of adverse reactions.
  
  
  RESULTS
  Three trials (four papers) involving 368 participants were included. All four papers had methodological flaws. Overall, 173 participants received M w and 168 participants received placebo or no control. M w immunotherapy was effective at reducing time to sputum conversion at days 15 (RR 2.31; 95% CI 1.75 to 3.06; P < 0.001) and 30 (RR 1.83; 95% CI 1.12 to 2.98; P = 0.02). After day 30, benefit was only demonstrated in the category II TB (re-treatment).
  
  
  CONCLUSIONS
  The meta-analysis suggests benefit as regards the time to sputum conversion. The available data on M w immunotherapy for participants with PTB are however methodologically flawed. We advise that M w be investigated in a well-structured, randomised controlled trial.
authors.forename: Shaheen
authors.initials: S
authors.lastname: Pandie
authors.forename: Mark E
authors.initials: ME
authors.lastname: Engel
authors.forename: Zita S
authors.initials: ZS
authors.lastname: Kerbelker
authors.affiliation: Department of Medicine, Old Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa. bongani.mayosi@uct.ac.za.
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
mesh_terms: D006801:Humans; D007167:Immunotherapy; D009161:Mycobacterium / Q000276:immunology*; D014397:Tuberculosis, Pulmonary / Q000628:therapy*