Treatment outcomes of extensively drug-resistant tuberculosis in Europe: a retrospective cohort study.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 40697337.
- Also identified by DOI 10.1016/j.lanepe.2025.101380 and PMC identifier 12281379.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
In 2021, World Health Organization revised of definition of extensive drug-resistant tuberculosis. We aimed to determine treatment outcomes of individuals affected by extensively drug-resistant tuberculosis in Europe. This observational, retrospective cohort study included patients diagnosed with extensively drug-resistant tuberculosis in the World Health Organization European Region from 2017 to 2023. Participating centres collected consecutive, detailed individual data for extensively drug-resistant tuberculosis patients. Data were analysed with meta- and regression methods, accounting for between-country heterogeneity. Among 11,003 patients with multidrug-resistant/rifampicin-resistant tuberculosis, 188 (1·7%) from 16 countries had extensively drug-resistant tuberculosis. Of these, 48·4% harboured strains with resistance to bedaquiline (n = 91/188), 34·0% to linezolid (n = 64/188), and 17·6% to both (n = 33/188). The individual composition of anti-tuberculosis regimens was highly variable, with 151 different drug combinations. Among the 156/188 (83·0%) patients with available treatment outcomes, the pooled percentage of successful outcomes was 40·2% (95% confidence interval [95% CI] 28·4%-53·2%). In patients with unsuccessful treatment outcomes (101/156), most experienced treatment failure (n = 57/156 [pooled proportion 37·1%], 95% CI: 26·1%-49·7%) or death (n = 30/156 [pooled proportion 21·3%], 95% CI: 15·7%-28·2%). After adjustment for disease severity, each additional likely effective drug decreased the odds of unsuccessful outcomes (adjusted odds ratio: 0·65, 95% CI: 0·45-0·96) (p = 0·026), whereas being treated in an upper-middle-income country increased the odds of unsuccessful outcomes compared with being treated in a high-income country (adjusted odds ratio: 13·7, 95% CI: 3·7-50·2) (p < 0·001). Compared with other levels of drug resistance, treatment outcomes were significantly worse for extensively drug-resistant tuberculosis. Only four out of ten patients affected by extensively drug-resistant tuberculosis achieved successful treatment outcomes. These findings highlight the need for adequate, individualised treatment regimens and optimised drug susceptibility testing. None.