Bedaquiline, moxifloxacin, pretomanid, and pyrazinamide during the first 8 weeks of treatment of patients with drug-susceptible or drug-resistant pulmonary tuberculosis: a multicentre, open-label, partially randomised, phase 2b trial

This study is registered with ClinicalTrials.gov, NCT02193776, and all patients have completed follow-up.FindingsBetween Oct 24, 2014, and Dec 15, 2015, we enrolled 180 patients with drug-susceptible tuberculosis (59 were randomly assigned to BloadPaZ, 60 to B200PaZ, and 61 to HRZE) and 60 patients with rifampicin-resistant tuberculosis. 57 patients in the BloadPaZ group, 56 in the B200PaZ group, and 59 in the HRZE group were included in the primary analysis. B200PaZ produced the highest daily percentage change in TTP (5·17% [95% Bayesian credibility interval 4·61–5·77]), followed by BloadPaZ (4·87% [4·31–5·47]) and HRZE group (4·04% [3·67–4·42]). The bactericidal activity in B200PaZ and BloadPaZ groups versus that in the HRZE group was significantly different. Higher proportions of patients in the BloadPaZ (six [10%] of 59) and B200PaZ (five [8%] of 60) groups discontinued the study drug than in the HRZE group (two [3%] of 61) because of adverse events. Liver enzyme elevations were the most common grade 3 or 4 adverse events and resulted in the withdrawal of ten patients (five [8%] in the BloadPaZ group, three [5%] in the B200PaZ group, and two [3%] in the HRZE group). Serious treatment-related adverse events affected two (3%) patients in the BloadPaZ group and one (2%) patient in the HRZE group. Seven (4%) patients with drug-susceptible tuberculosis died and four (7%) patients with rifampicin-r...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research

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Background: Understanding the clinical features of XDR-TB makes it possible to identify its predictors and organize the treatment of these patients.Methods: analyzed and compared records of patients with XDR-TB (708), MDR-TB, excludes XDR-TB (3469) and drug-sensitive TB (4320) by registration group, age, gender, presence of HIV, proportion of rural population, frequency of bacterial excretion by smear microscopy.Results: In the XDR-TB group, patients prevailed after treatment failure (67.5% compared to 48.9% in the MDR-TB group and 5.6% in the drug-sensitive TB group; p 0.05), 1.9% for drug-susceptible TB. The median age i...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Tuberculosis Source Type: research
Most Cochrane Reviews look at the effects of interventions on health, but a growing number provide evidence on how to diagnose a disease. In June 2019, one of these, on a test used to detect tuberculosis, was updated. The lead author, David Horne from the University of Washington in Seattle in the USA, sets the scene and tells us what the review found.Tuberculosis, or TB, causes more deaths than any other infectious disease: 1.6 million people died from it in 2017. Most of these deaths could have been averted with earlier detection. The early diagnosis of TB is also important to prevent disease progression and long-term co...
Source: Cochrane News and Events - Category: Information Technology Authors: Source Type: news
Publication date: Available online 17 October 2019Source: EpidemicsAuthor(s): Yayehirad A. Melsew, Adeshina I. Adekunle, Allen C. Cheng, Emma S. McBryde, Romain Ragonnet, James M. TrauerAbstractTB mathematical models employ various assumptions and approaches in dealing with the heterogeneous infectiousness of persons with active TB. We reviewed existing approaches and considered the relationship between them and existing epidemiological evidence.We searched the following electronic bibliographic databases from inception to 9 October 2018: MEDLINE, EMBASE, Biosis, Global Health and Scopus. Two investigators extracted data u...
Source: Epidemics - Category: Epidemiology Source Type: research
Abstract Human immunodeficiency virus/Tuberculosis (HIV/TB) coinfection is particularly prevalent in South Africa, where TB has been the leading cause of death for more than a decade. The 2004-2008 national rollout of antiretroviral therapy (ART) provides a unique opportunity to examine the population-level impact of ART on the TB epidemic. We performed longitudinal regression analysis to follow the evolution of TB outcomes before and after the introduction of ART using a large data set from the National Health Laboratory Service. This is the first study to produce estimates of the impact of the ART rollout by exp...
Source: The American Journal of Tropical Medicine and Hygiene - Category: Tropical Medicine Authors: Tags: Am J Trop Med Hyg Source Type: research
TB diagnosis and treatment monitoring in resource limited regions rely heavily on serial sputum smear microscopy and bacterial culture. These microbiological methods are time-consuming, expensive and lack adequate sensitivity. The WHO states that improved TB diagnosis and treatment is imperative to achieve an end to the TB epidemic by 2030. Commercially available lipoarabinomannan (LAM) detection tools perform at low sensitivity that are highly dependent on the underlying immunological status of the patient; those with advanced HIV infection perform well.
Source: Tuberculosis - Category: Respiratory Medicine Authors: Source Type: research
Abstract ObjectivesIn June 2015, Partners in Health (PIH) and the Liberian Ministry of Health began a community health worker (CHW) program containing food support, reimbursement of transport and social assistance to address gaps in tuberculosis (TB) treatment exacerbated by the 2014‐2015 Ebola‐virus disease (EVD) epidemic. The purpose of this article is to analyze the performance of routine clinical TB care and the effects of this CHW program. MethodsRetrospective cohort study utilizing data from TB patient registers at a census of all health facilities treating TB in southeastern Liberia from January 2015 – Apr...
Source: Tropical Medicine and International Health - Category: Tropical Medicine Authors: Tags: Original Article Source Type: research
Abstract ObjectivesThe poor detection rate of multidrug‐resistant tuberculosis (MDR‐TB) highlights the urgent need to explore new case finding model to improve the detection of MDR‐TB in China. The aim of this study was to evaluate the feasibility of a new model that combines molecular diagnostics and sputum transportation for early detection of patients with MDR‐TB in Zhejiang. MethodsFrom May 2014 to January 2015, TB suspects were continuously enrolled at six county‐level designated TB hospitals in Zhejiang. Each patient gave three sputum samples, which were submitted to laboratory for smear microscopy, solid c...
Source: Tropical Medicine and International Health - Category: Tropical Medicine Authors: Tags: Original Article Source Type: research
Abstract ObjectivesThe poor detection rate of multidrug‐resistant tuberculosis (MDR‐TB) highlights the urgent need to explore new case finding model to improve the detection of MDR‐TB in China. The aim of this study was to evaluate the feasibility of a new model that combines molecular diagnostics and sputum transportation for early detection of MDR‐TB patients in Zhejiang. MethodsFrom May 2014 to January 2015, TB suspects were continuously enrolled at 6 county‐level designated TB hospitals in Zhejiang. Each patient gave three sputum samples, which were submitted to laboratory for smear microscopy, solid culture ...
Source: Tropical Medicine and International Health - Category: Tropical Medicine Authors: Tags: Original Article Source Type: research
CONCLUSIONS: The burdens of both TB and co-infection were high in this community, although HIV prevalence varied. Mortality was higher and treatment completion lower in co-infected patients than in those who were HIV-negative. Co-infection, previous TB treatment and smear not done were significant risk factors for an unfavourable outcome in all patients. PMID: 28492125 [PubMed - in process]
Source: South African Medical Journal - Category: African Health Tags: S Afr Med J Source Type: research
Conclusion DM adversely affected the clinical presentation and treatment response of TB, but there was no difference in the drug resistance and relapse rates.
Source: Respirology - Category: Respiratory Medicine Authors: Tags: Original Article Source Type: research
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