Global treatment outcomes of extensively drug-resistant tuberculosis in adults: A systematic review and meta-analysis

• Published in: The Journal of infection 2023-09, Vol.87 (3), p.177-189
• Main Authors: Pedersen, Ole Skouvig, Holmgaard, Freja Breth, Mikkelsen, Mads Kristian Duborg, Lange, Christoph, Sotgiu, Giovanni, Lillebaek, Troels, Andersen, Aase Bengaard, Wejse, Christian Morberg, Dahl, Victor Naestholt
• Format: Article
• Language: English
• Subjects: Adult; Antitubercular Agents - therapeutic use; Drug-resistant tuberculosis; Extensively drug-resistant tuberculosis; Extensively Drug-Resistant Tuberculosis - drug therapy; Female; Humans; Pre-extensively drug-resistant tuberculosis; Pregnancy; Treatment Outcome; Treatment outcomes; Tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Pulmonary - drug therapy
• ISSN: 0163-4453; 1532-2742; 1532-2742
• DOI: 10.1016/j.jinf.2023.06.014

Historically, extensively drug-resistant tuberculosis has been notoriously difficult to treat with devasting outcomes. As we are coming to the end of an era where the 2006 extensively drug-resistant tuberculosis definitions and old treatment regimens are being replaced, we aimed to estimate the proportion of extensively drug-resistant tuberculosis patients globally who achieved successful treatment outcomes. We conducted a systematic review of PubMed/MEDLINE, Scopus, Web of Science, and Embase from January 1, 2005, through April 3, 2023. Included studies reported WHO treatment outcomes, or adaptions hereof, for pre-extensively and/or extensively drug-resistant tuberculosis patients according to the 2006 WHO definition. Eligible studies included cohorts of at least 10 adults (aged>18 years) that were not pregnant. Using a random-effects model, we calculated pooled proportions of treatment outcomes and performed sensitivity and subgroup analyses. PROSPERO registration number: CRD42022340961. Among 5056 studies reviewed, we identified 94 studies from 26 countries, involving 10,223 extensively drug-resistant tuberculosis patients. The pooled proportion of successful treatment outcomes was 44.2% (95%CI: 38.3–50.3). Sensitivity analyses consistently produced similar estimates. A slight improvement in treatment outcomes was observed after 2013. Furthermore, 25 studies reported outcomes for 3564 individuals with pre-extensively drug-resistant tuberculosis, of which 63.3% achieved successful treatment (95%CI: 43.1–72.5). Globally, the success rate of extensively drug-resistant tuberculosis treatment is 44.2%, far below the WHO’s target rate of 75%. These results may serve as a reference for future studies assessing extensively drug-resistant tuberculosis treatment outcomes under the 2021 definition treated with better treatment regimens available. Comprehensive surveillance data of extensively drug-resistant tuberculosis outcomes from the whole world are desirable to monitor treatment progress.