Shortened nine-month MDR-TB treatment works well in children and adolescents
1 August 2016. Related: Conference reports, Paediatric care, TB coinfection, TB 2016 Durban.
Polly Clayden, HIV i-Base
The nine-month Bangladesh regimen for treatment of multidrug-resistant tuberculosis (MDR-TB) was successful in 83% of children and adolescents in an observational trial conducted in francophone Africa, presented at TB2016. [1]
Preliminary results presented previously at the 46th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease (The Union) in 2015 showed the regimen to be successful in 82% of adults participating in the study. It was coordinated by The Union and from January 2013 to March 2015 recruited participants in: Benin, Burkina Faso, Burundi, Cameroon, Ivory Coast, Niger, Central African Republic, Democratic Republic of Congo and Rwanda. [2,3]
The regimen was: four months of kanamycin, moxifloxacin, prothionamide, isoniazid, clofazamine, ethambutol, and pyrazinamide (4 Km Mfx Pto H Cfz E Z), and then five months of moxifloxacin, clofazamine, ethambutol and pyrazinamide (5 Mfx Cfz E Z). Treatment was directly observed throughout the study.
Bassirou Souleymane from Action Damien Niger showed the findings from the Bangladesh regimen for children and adolescents study in an oral presentation.
The investigators collected data on all participants aged less than 18 years who were diagnosed with rifampicin-resistant TB and treated with the regimen during the inclusion period of the study
Forty-eight children and adolescents were started on treatment with the Bangladesh regimen: 23 (48%) girls, 5 (10%) aged 0-9 years, 9 (19%) HIV positive, and 30 (63%) previously treated for TB.
Treatment was successful in 83% of participants (56% cured, 27% treatment completed), and there was no significant difference by age (85% in 15-17 vs 80% in 0-15 year-olds). There were more deaths among participants with HIV than those without (22% vs 5%), but treatment success was similar according to HIV status among surviving participants (100% vs 92%).
Adverse events were reported in 62% of the participants, none of which was severe. Of 24 participants assessed after treatment ended, 21 were alive with confirmed treatment success, two had died and one had recurrence.
The investigators concluded that treatment with the nine-month Bangladesh regimen appeared to be excellent in children and adolescents irrespective of HIV status with very limited side effects. They encourage countries to adopt the shortened MDR-TB treatment regimen in this population.
References:
- Bakayoko-Yeo-Tenena A et al. Treatment of multidrug-resistant tuberculosis (MDR-TB) in children and adolescents with a 9-month regimen in Africa. TB2016. 16-17 July 2016. Durban, South Africa. Oral abstract 220. Code P38.
- Clayden P. Promising first results with a 9-month regimen for multidrug resistant tuberculosis in French-speaking African countries. HTB. 1 February 2016.
https://i-base.info/htb/29604 - Kuaban C et al. First results with a 9-month regimen for multidrug-resistant tuberculosis (MDRTB) in francophone Africa. 46th World Health Conference on Lung Health of the International Union Against Tuberculosis and lung Disease. 2 – 6 December 2015, Cape Town. LB CDC.
http://tinyurl.com/hjwp2j3
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