Directly Observed Therapy Decreases Mortality in Multidrug Resistant TB

Mycobacterium tuberculosis
Mycobacterium tuberculosis
While directly observed therapy is standard care in TB, study data confirms the efficacy of this treatment method.

A decrease in all-cause mortality associated with multidrug-resistant tuberculosis (TB) can be correlated with an increase in directly observed therapy, according to research presented at the American Thoracic Society (ATS) 2017 International Conference, held May 19-24 in Washington, DC.1

Researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, analyzed surveillance data collected for US patients with multidrug-resistant TB between 1993 and 2013 to determine the association between TB treatment method — directly observed therapy or self-administered therapy — and all-cause mortality during treatment.

In total, data were examined from 3434 patients with multidrug-resistant TB (majority being of Asian [50%] or Hispanic [33%] race/ethnicity); 21% died while undergoing TB treatment. Reported patient comorbidities included HIV infection (34%), previous TB (18%), and additional drug resistance (17%).

Between 1993 and 2002, directly observed therapy was employed in 74% of cases; between 2002 and 2013, this increased to 95%, correlated with a decrease in all-cause mortality from 31% to 11% (1993-2002 and 2002-2013, respectively).

Regardless of treatment method, older age and HIV infection were risk factors for all-cause mortality (adjusted hazard ratio [aHR]: 1.15 and 7.11; 95% CI, 1.11-1.20 and 5.46-9.24, respectively). In all stratified models, directly observed therapy was protective of all-cause mortality (aHR: 0.23; 95% CI, 0.19-0.28).

“This protective effect may come from [directly observed therapy] alone or from other patient-centered measures, such as transportation assistance or food stamps given along with [directly observed therapy] by TB treatment facilities to improve adherence,” said Jorge Salinas, MD, epidemic intelligence service officer at the CDC, in a press release.2 “The findings reinforce that all patients with [multidrug resistant] TB should receive [directly observed therapy] and other patient-centered measures to ensure patients complete their treatment.”

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  1. Salinas JL, Armstrong LR, Cegielski JP, Haddad MB, Silk BJ. Factors associated with mortality among patients with multidrug-resistant tuberculosis—United States, 1993-2013. Presented at: 2017 American Thoracic Society (ATS) International Conference; Washington, DC; May 19-24. Abstract 5304.
  2. Directly observed therapy for multidrug-resistant TB decreases mortality. New York, NY: American Thoracic Society. Published May 17, 2017. Accessed June 23, 2017.