The use of clofazimine in multidrug-resistant tuberculosis: a report from Brazil.
Although clofazimine is used to treat multidrug-resistant tuberculosis (MDR-TB), there is scant information on its effectiveness and safety.
The aim of this retrospective, observational study was to evaluate these factors as well as the tolerability of clofazimine in populations in Brazil, where it was administered at a daily dose of 100 mg·day-1 (body weight ≥45 kg) as part of a standardised MDR-TB treatment regimen until 2006 (thereafter pyrazinamide was used).
All MDR-TB patients included in the Sistema de Informação de Tratamentos Especiais da Tuberculose (SITETB) individual electronic register were analysed. The effectiveness of clofazimine was assessed by comparing the treatment outcomes of patients undergoing clofazimine-containing regimens against those undergoing clofazimine-free regimens and its safety by describing clofazimine-attributed adverse events. A total of 1446 patients were treated with clofazimine-containing regimens and 1096 with pyrazinamide-containing regimens.
Although success rates were similar in patients treated with clofazimine versus those treated with pyrazinamide (880 out of 1446, 60.9%, versus 708 out of 1096, 64.6%; p=0.054), clofazimine-treated cases exhibited higher death rates due to tuberculosis than pyrazinamide-treated ones (314 out of 1446, 21.7%, versus 120 out of 1096, 10.9%) but fewer failures (78 out of 1446, 5.4%, versus 95 out of 1096, 8.7%) and less loss to follow-up (144 out of 1446, 10.0%, versus 151 out of 1096, 13.8%).
No relevant differences were detected when comparing adverse events in patients treated with clofazimine-containing regimens to those treated with clofazimine-free regimens.
However, the incidence of side-effects was less than previously reported (gastro-intestinal complaints: 10.5%; hyper-pigmentation: 50.2%; neurological disturbances: 9-13%).
AUTHORS: Dalcolmo M, Gayoso R, Sotgiu G, D'Ambrosio L, Rocha JL, Borga L, Fandinho F, Braga JU, Galesi VM, Barreira D, Sanchez DA, Dockhorn F, Centis R, Caminero JA, Migliori GB.
Read the full article here: erj.ersjournals.com/content/49/3/1602445.
The Global Laboratory Initiative: TB Diagnostic Algorithms.
This week WAidid suggests to read "The Global Laboratory Initiative. GLI Model TB Diagnostic Algorithms".
The Global Laboratory Initiative has released this handbook that provides 4 model algorithms that graphically depict the most up-to-date WHO recommendations on use of TB diagnostics.
The algorithms follow the principles of the End TB Strategy to provide universal access to rapid testing for Mycobacterium tuberculosis complex bacteria (MTB) and drug susceptibility testing (DST), and include the use of Xpert MTB/RIF, line probe assays for 2nd line drugs, the lateral flow urine lipoarabinomannan (LF-LAM) assay and the loop-mediated isothermal amplification (TB-LAMP) test, together with conventional tools including microscopy and phenotypic culture and DST.
The 4 algorithms, which are illustrative and must be adapted by countries to the local situation, include:
a preferred algorithm for universal patient access to rapid testing to detect MTB and rifampicin resistance;
an interim algorithm moving towards universal access, with rapid testing for priority populations;
an algorithm for testing for second-line drug resistance among rifampicin-resistant TB or MDR-TB patients;
an algorithm for evaluating persons for TB, among PLHIV who are seriously ill with danger signs or have CD4 counts ≤ 100 cells/μl.
AUTHORS: Wayne van Gemert, Thomas Shinnick and Heidi Albert, Heather Alexander, Martina Casenghi, Lucilaine Ferrazoli, Levan Gagnidze, Alaine Umubyeyi Nyaruhirira, Amy Piatek, Alena Skrahina, Khairunisa Suleiman, Elisa Tagliani, Sabira Tahseen, Nguyen Van Hung, Maarten van Cleeff, Chen-Yuan Chiang, Daniela Cirillo, Agnes Gebhard, Dennis Falzon, Fuad Mirzayev, Alexei Korobitsyn, Christopher Gilpin, Ernesto Jaramillo, Annabel Baddeley, Yohhei Hamada, Avinash Kanchar and Karin Weyer, Rumina Hasan, Richard Lumb, Arnaud Trebucq, Armand Van Deun and Fraser Wares.
Read the full article here.