A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020

TL;DR

This study reviews 10 years of managing isoniazid-resistant TB in Uzbekistan, finding that a specific drug regimen is effective and safer than others.

Contribution

The study evaluates real-world effectiveness of the WHO-recommended regimen for isoniazid-resistant TB in Uzbekistan over a decade.

Findings

The 6REZLfx regimen achieved a 92.0% treatment success rate with short duration and no resistance amplification.

Regimens containing injections had lower success and higher loss to follow-up compared to non-injection regimens.

Unsuccessful outcomes were more common in older patients, males, and those with diabetes or smear-positive TB.

Abstract

Isoniazid (INH, H) resistance is the most common drug-resistant TB pattern, with treatment success rates lower than those in drug-susceptible TB. The WHO recommends a 6-month regimen of rifampicin (RIF, R), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (Lfx) (6REZLfx) for INH-resistant, RIF-susceptible TB (HRRS-TB). Uzbekistan has a high burden of TB (62/100,000 population) and multidrug-resistant TB (12/100,000 population).

We conducted a retrospective, descriptive study of microbiologically confirmed HRRS-TB using routinely collected programmatic data from 2009 to 2020.

We included 854 HRRS-TB cases. Treatment success was 80.2% overall. For REZLfx, the treatment success rate was 92.0% over a short treatment duration, with no amplifications to RIF or second-line anti-TB drug resistance. We documented 46 regimens with REZLfx plus linezolid (success 87.0%) and 539 regimens using kanamycin or capreomycin (success 76.6%). We identified 37 treatment failures (4.3%), 30 deaths (3.5%), 25 resistance amplifications (2.9%), including eight to RIF (0.9%), and 99 lost to follow-up (LTFU) cases (11.6%). Unsuccessful outcomes were more common with older age, diabetes, chest X-ray cavities, smear positivity, smear-positive persistence, and male sex. LTFU was more common with injection-containing regimens.

REZLfx is a safe and effective first-line treatment for INH-resistant, RIF-susceptible TB. Treatment success was lower and LTFU was higher for injection-containing regimens.

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