Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia

A retrospective cohort study

Vaira Leimane, Vija Riekstina, Timothy H. Holtz, Evija Zarovska, Vija Skripconoka, Lorna Thorpe, Kayla F. Laserson, Charles D. Wells

Research output: Contribution to journalReview article

Abstract

Background Latvia has one of the highest rates of multidrug-resistant tuberculosis (MDRTB). Our aim was to assess treatment outcomes for the first full cohort of MDRTB patients treated under Latvia's DOTS-Plus strategy following WHOguidelines. Methods We retrospectively reviewed all civilian patients who began treatment with individualised treatment regimens for pulmonary MDRTB in Latvia between Jan 1, and Dec 31, 2000. We applied treatment outcome definitions for MDRTB, developed by an international expert consensus group, and assessed treatment effectiveness and risk factors associated with poor outcome. Findings Of the 204 patients assessed, 55 (27%) had been newly diagnosed with MDRTB, and 149 (73%) had earlier been treated with first-line or second-line drugs for this disease. Assessment of treatment outcomes showed that 135 (66%) patients were cured or completed therapy, 14 (7%) died, 26 (13%) defaulted, and treatment failed in 29 (14%). Of the 178 adherent patients, 135 (76%) achieved cure or treatment completion. In a multivariate Cox proportional-hazards model of these patients, independent predictors of poor outcome (death and treatment failure) included having previously received treatment for MDRTB (hazard ratio 5·7, 95% CI 1·9-16·6), the use of five or fewer drugs for 3 months or more (3·2, 1·1-9·6), resistance to ofloxacin (2·6, 1·2-5·4), and body-mass index less than 18·5 at start of treatment (2·3, 1·1-4·9). Interpretation The DOTS-Plus strategy of identifying and treating patients with MDRTB can be effectively implemented on a nationwide scale in a setting of limited resources.

Original languageEnglish (US)
Pages (from-to)318-326
Number of pages9
JournalLancet
Volume365
Issue number9456
DOIs
StatePublished - Jan 22 2005

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Latvia
Multidrug-Resistant Tuberculosis
Cohort Studies
Retrospective Studies
Therapeutics
Ofloxacin
Treatment Failure
Pulmonary Tuberculosis
Proportional Hazards Models
Pharmaceutical Preparations
Body Mass Index

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Leimane, V., Riekstina, V., Holtz, T. H., Zarovska, E., Skripconoka, V., Thorpe, L., ... Wells, C. D. (2005). Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia: A retrospective cohort study. Lancet, 365(9456), 318-326. https://doi.org/10.1016/S0140-6736(05)17786-1

Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia : A retrospective cohort study. / Leimane, Vaira; Riekstina, Vija; Holtz, Timothy H.; Zarovska, Evija; Skripconoka, Vija; Thorpe, Lorna; Laserson, Kayla F.; Wells, Charles D.

In: Lancet, Vol. 365, No. 9456, 22.01.2005, p. 318-326.

Research output: Contribution to journalReview article

Leimane, V, Riekstina, V, Holtz, TH, Zarovska, E, Skripconoka, V, Thorpe, L, Laserson, KF & Wells, CD 2005, 'Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia: A retrospective cohort study', Lancet, vol. 365, no. 9456, pp. 318-326. https://doi.org/10.1016/S0140-6736(05)17786-1
Leimane, Vaira ; Riekstina, Vija ; Holtz, Timothy H. ; Zarovska, Evija ; Skripconoka, Vija ; Thorpe, Lorna ; Laserson, Kayla F. ; Wells, Charles D. / Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia : A retrospective cohort study. In: Lancet. 2005 ; Vol. 365, No. 9456. pp. 318-326.
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abstract = "Background Latvia has one of the highest rates of multidrug-resistant tuberculosis (MDRTB). Our aim was to assess treatment outcomes for the first full cohort of MDRTB patients treated under Latvia's DOTS-Plus strategy following WHOguidelines. Methods We retrospectively reviewed all civilian patients who began treatment with individualised treatment regimens for pulmonary MDRTB in Latvia between Jan 1, and Dec 31, 2000. We applied treatment outcome definitions for MDRTB, developed by an international expert consensus group, and assessed treatment effectiveness and risk factors associated with poor outcome. Findings Of the 204 patients assessed, 55 (27{\%}) had been newly diagnosed with MDRTB, and 149 (73{\%}) had earlier been treated with first-line or second-line drugs for this disease. Assessment of treatment outcomes showed that 135 (66{\%}) patients were cured or completed therapy, 14 (7{\%}) died, 26 (13{\%}) defaulted, and treatment failed in 29 (14{\%}). Of the 178 adherent patients, 135 (76{\%}) achieved cure or treatment completion. In a multivariate Cox proportional-hazards model of these patients, independent predictors of poor outcome (death and treatment failure) included having previously received treatment for MDRTB (hazard ratio 5·7, 95{\%} CI 1·9-16·6), the use of five or fewer drugs for 3 months or more (3·2, 1·1-9·6), resistance to ofloxacin (2·6, 1·2-5·4), and body-mass index less than 18·5 at start of treatment (2·3, 1·1-4·9). Interpretation The DOTS-Plus strategy of identifying and treating patients with MDRTB can be effectively implemented on a nationwide scale in a setting of limited resources.",
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T1 - Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia

T2 - A retrospective cohort study

AU - Leimane, Vaira

AU - Riekstina, Vija

AU - Holtz, Timothy H.

AU - Zarovska, Evija

AU - Skripconoka, Vija

AU - Thorpe, Lorna

AU - Laserson, Kayla F.

AU - Wells, Charles D.

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N2 - Background Latvia has one of the highest rates of multidrug-resistant tuberculosis (MDRTB). Our aim was to assess treatment outcomes for the first full cohort of MDRTB patients treated under Latvia's DOTS-Plus strategy following WHOguidelines. Methods We retrospectively reviewed all civilian patients who began treatment with individualised treatment regimens for pulmonary MDRTB in Latvia between Jan 1, and Dec 31, 2000. We applied treatment outcome definitions for MDRTB, developed by an international expert consensus group, and assessed treatment effectiveness and risk factors associated with poor outcome. Findings Of the 204 patients assessed, 55 (27%) had been newly diagnosed with MDRTB, and 149 (73%) had earlier been treated with first-line or second-line drugs for this disease. Assessment of treatment outcomes showed that 135 (66%) patients were cured or completed therapy, 14 (7%) died, 26 (13%) defaulted, and treatment failed in 29 (14%). Of the 178 adherent patients, 135 (76%) achieved cure or treatment completion. In a multivariate Cox proportional-hazards model of these patients, independent predictors of poor outcome (death and treatment failure) included having previously received treatment for MDRTB (hazard ratio 5·7, 95% CI 1·9-16·6), the use of five or fewer drugs for 3 months or more (3·2, 1·1-9·6), resistance to ofloxacin (2·6, 1·2-5·4), and body-mass index less than 18·5 at start of treatment (2·3, 1·1-4·9). Interpretation The DOTS-Plus strategy of identifying and treating patients with MDRTB can be effectively implemented on a nationwide scale in a setting of limited resources.

AB - Background Latvia has one of the highest rates of multidrug-resistant tuberculosis (MDRTB). Our aim was to assess treatment outcomes for the first full cohort of MDRTB patients treated under Latvia's DOTS-Plus strategy following WHOguidelines. Methods We retrospectively reviewed all civilian patients who began treatment with individualised treatment regimens for pulmonary MDRTB in Latvia between Jan 1, and Dec 31, 2000. We applied treatment outcome definitions for MDRTB, developed by an international expert consensus group, and assessed treatment effectiveness and risk factors associated with poor outcome. Findings Of the 204 patients assessed, 55 (27%) had been newly diagnosed with MDRTB, and 149 (73%) had earlier been treated with first-line or second-line drugs for this disease. Assessment of treatment outcomes showed that 135 (66%) patients were cured or completed therapy, 14 (7%) died, 26 (13%) defaulted, and treatment failed in 29 (14%). Of the 178 adherent patients, 135 (76%) achieved cure or treatment completion. In a multivariate Cox proportional-hazards model of these patients, independent predictors of poor outcome (death and treatment failure) included having previously received treatment for MDRTB (hazard ratio 5·7, 95% CI 1·9-16·6), the use of five or fewer drugs for 3 months or more (3·2, 1·1-9·6), resistance to ofloxacin (2·6, 1·2-5·4), and body-mass index less than 18·5 at start of treatment (2·3, 1·1-4·9). Interpretation The DOTS-Plus strategy of identifying and treating patients with MDRTB can be effectively implemented on a nationwide scale in a setting of limited resources.

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DO - 10.1016/S0140-6736(05)17786-1

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JO - The Lancet

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