title: Aggressive Regimens Reduce Risk of Recurrence After Successful Treatment of MDR-TB.
abstract: We sought to determine whether treatment with a "long aggressive regimen" was associated with lower rates of relapse among patients successfully treated for pulmonary multidrug-resistant tuberculosis (MDR-TB) in Tomsk, Russia.
  
  
  
  We conducted a retrospective cohort study of adult patients that initiated MDR-TB treatment with individualized regimens between September 2000 and November 2004, and were successfully treated. Patients were classified as having received "aggressive regimens" if their intensive phase consisted of at least 5 likely effective drugs (including a second-line injectable and a fluoroquinolone) used for at least 6 months post culture conversion, and their continuation phase included at least 4 likely effective drugs. Patients that were treated with aggressive regimens for a minimum duration of 18 months post culture conversion were classified as having received "long aggressive regimens." We used recurrence as a proxy for relapse because genotyping was not performed. After treatment, patients were classified as having disease recurrence if cultures grew MDR-TB or they re-initiated MDR-TB therapy. Data were analyzed using Cox proportional hazard regression.
  
  
  
  Of 408 successfully treated patients, 399 (97.5%) with at least 1 follow-up visit were included. Median duration of follow-up was 42.4 months (interquartile range: 20.5-59.5), and there were 27 recurrence episodes. In a multivariable complete case analysis (n = 371 [92.9%]) adjusting for potential confounders, long aggressive regimens were associated with a lower rate of recurrence (adjusted hazard ratio: 0.22, 95% confidence interval, .05-.92).
  
  
  
  Long aggressive regimens for MDR-TB treatment are associated with lower risk of disease recurrence.
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts Respiratory Epidemiology and Clinical Research Unit & McGill International TB Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Faiz
authors.initials: F
authors.lastname: Ahmad Khan
authors.affiliation: Partners In Health Russia, Moscow, Russian Federation.
authors.forename: Irina Y
authors.initials: IY
authors.lastname: Gelmanova
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Molly F
authors.initials: MF
authors.lastname: Franke
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Sidney
authors.initials: S
authors.lastname: Atwood
authors.affiliation: Partners In Health Russia, Moscow, Russian Federation Siberian State Medical University.
authors.forename: Nataliya A
authors.initials: NA
authors.lastname: Zemlyanaya
authors.affiliation: Tomsk Penitentiary Services, Ministry of Justice.
authors.forename: Irina A
authors.initials: IA
authors.lastname: Unakova
authors.affiliation: Tomsk Penitentiary Services, Ministry of Justice.
authors.forename: Yevgeniy G
authors.initials: YG
authors.lastname: Andreev
authors.affiliation: Tomsk Oblast Tuberculosis Services, Russian Federation.
authors.forename: Valentina I
authors.initials: VI
authors.lastname: Berezina
authors.affiliation: Tomsk Oblast Tuberculosis Services, Russian Federation.
authors.forename: Vera E
authors.initials: VE
authors.lastname: Pavlova
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts Partners In Health, Boston, Massachusetts.
authors.forename: Sonya S
authors.initials: SS
authors.lastname: Shin
authors.affiliation: Partners In Health, Boston, Massachusetts.
authors.forename: Askar B
authors.initials: AB
authors.lastname: Yedilbayev
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts Partners In Health, Boston, Massachusetts.
authors.forename: Mercedes C
authors.initials: MC
authors.lastname: Becerra
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts Partners In Health, Boston, Massachusetts.
authors.forename: Salmaan
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D055502:Secondary Prevention; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents
keywords: anti-tuberculosis treatment; multidrug-resistant tuberculosis; tuberculosis recurrence; tuberculosis relapse