Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis.
Evidence-based recommendations for treating persons having presumed latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) tuberculosis (TB) are lacking because published data consist of small observational studies. Tuberculosis incidence in persons treated for latent MDR -TB infection is unknown.
We conducted a systematic review of studies published 1 January 1994-31 December 2014 to analyze TB incidence, treatment completion and discontinuation, and cost-effectiveness. We considered contacts with LTBI effectively treated if they were on ≥1 medication to which their MDR-TB strain was likely susceptible. We selected studies that compared treatment vs nontreatment outcomes and performed a meta-analysis to estimate the relative risk of TB incidence and its 95% confidence interval.
We abstracted data from 21 articles that met inclusion criteria. Six articles presented outcomes for contacts who were treated compared with those not treated for MDR-LTBI; 10 presented outcomes only for treated contacts, and 5 presented outcomes only for untreated contacts. The estimated MDR-TB incidence reduction was 90% (9%-99%) using data from 5 comparison studies. We also found high treatment discontinuation rates due to adverse effects in persons taking pyrazinamide-containing regimens. Cost-effectiveness was greatest using a fluoroquinolone/ethambutol combination regimen.
Few studies met inclusion criteria, therefore results should be cautiously interpreted. We found a reduced risk of TB incidence with treatment for MDR-LTBI, suggesting effectiveness in prevention of progression to MDR-TB, and confirmed cost-effectiveness. However, we found that pyrazinamide-containing MDR-LTBI regimens often resulted in treatment discontinuation due to adverse effects.
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention,Atlanta, Georgia.
Suzanne M
SM
Marks
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention,Atlanta, Georgia.
Sundari R
SR
Mase
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention,Atlanta, Georgia.
Sapna Bamrah
SB
Morris
D000995:Antitubercular Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D004977:Ethambutol / Q000191:economics / Q000627:therapeutic use; D024841:Fluoroquinolones / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D055985:Latent Tuberculosis / Q000188:drug therapy* / Q000191:economics; D011718:Pyrazinamide / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000191:economics
D000995:Antitubercular Agents; D024841:Fluoroquinolones; D011718:Pyrazinamide; D004977:Ethambutol
contacts; cost.; multidrug-resistant; treatment; tuberculosis