Directly Observed Therapy Decreases Mortality in Multidrug Resistant TB

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.”

References

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. http://www.thoracic.org/about/newsroom/press-releases/conference/2017/salinas-and-mdr-tb.php. Published May 17, 2017. Accessed June 23, 2017.