Abstract：
BACKGROUND: Contacts of patients with multidrug-resistant tuberculosis (MDR-TB) are at risk of developing TB disease. Tuberculosis preventive treatment (TPT) is an intervention that can potentially reduce this risk.
OBJECTIVE: To evaluate the effectiveness and safety of TPT for contacts of patients with MDR-TB.
METHODS: EMBASE, PubMed, Web of Science, and the Cochrane Library were searched for eligible studies on 24 July 2023, without start date restrictions.
METHODS: We included studies that compared TPT with no treatment in contacts of patients with MDR-TB and reported outcomes of progression to TB disease.
METHODS: Contacts of patients with MDR-TB.
METHODS: TPT.
UNASSIGNED: A modified version of the Newcastle-Ottawa Scale was used.
UNASSIGNED: Random-effects meta-analysis was utilized to calculate the relative risk for disease progression to TB in contacts of patients with MDR-TB who received TPT compared to those who did not. Additionally, completion, adverse effect, and discontinued rates were assessed.
RESULTS: Involving 1105 individuals from 11 studies, the pooled relative risk for disease progression in contacts receiving TPT versus those without treatment was 0.34 (95% CI: 0.16-0.72). Subgroup analysis indicated a lower pooled relative risk for regimens based on the drug-resistance profile of the index patients with TB compared to uniform treatment regimens (0.22 [95% CI: 0.06-0.84] vs. 0.49 [95% CI: 0.17-1.35]), although not statistically significant. The pooled completed rate was 83.8%, adverse effect rate was 22.9%, and discontinued rate was 6.5%. After excluding the levofloxacin and pyrazinamide regimen study, the completed rate increased to 88.0%, and adverse effects and discontinued rates decreased to 8.0% and 4.0%, respectively.
CONCLUSIONS: TPT reduces TB disease progression risk in contacts of patients with MDR-TB. Tailored TPT regimens based on drug-resistance profiles may offer additional benefits. Furthermore, efforts to improve completed rates and manage adverse effects are essential for optimizing effectiveness and safety.
OBJECTIVE: To evaluate the effectiveness and safety of TPT for contacts of patients with MDR-TB.
METHODS: EMBASE, PubMed, Web of Science, and the Cochrane Library were searched for eligible studies on 24 July 2023, without start date restrictions.
METHODS: We included studies that compared TPT with no treatment in contacts of patients with MDR-TB and reported outcomes of progression to TB disease.
METHODS: Contacts of patients with MDR-TB.
METHODS: TPT.
UNASSIGNED: A modified version of the Newcastle-Ottawa Scale was used.
UNASSIGNED: Random-effects meta-analysis was utilized to calculate the relative risk for disease progression to TB in contacts of patients with MDR-TB who received TPT compared to those who did not. Additionally, completion, adverse effect, and discontinued rates were assessed.
RESULTS: Involving 1105 individuals from 11 studies, the pooled relative risk for disease progression in contacts receiving TPT versus those without treatment was 0.34 (95% CI: 0.16-0.72). Subgroup analysis indicated a lower pooled relative risk for regimens based on the drug-resistance profile of the index patients with TB compared to uniform treatment regimens (0.22 [95% CI: 0.06-0.84] vs. 0.49 [95% CI: 0.17-1.35]), although not statistically significant. The pooled completed rate was 83.8%, adverse effect rate was 22.9%, and discontinued rate was 6.5%. After excluding the levofloxacin and pyrazinamide regimen study, the completed rate increased to 88.0%, and adverse effects and discontinued rates decreased to 8.0% and 4.0%, respectively.
CONCLUSIONS: TPT reduces TB disease progression risk in contacts of patients with MDR-TB. Tailored TPT regimens based on drug-resistance profiles may offer additional benefits. Furthermore, efforts to improve completed rates and manage adverse effects are essential for optimizing effectiveness and safety.
摘要：
背景：耐多药结核病（MDR-TB）患者的接触者有发展为结核病的风险。结核病预防性治疗（TPT）是一种干预措施，可以潜在地降低这种风险。
目的：评价TPT用于耐多药结核病患者接触的有效性和安全性。
方法：EMBASE，PubMed,WebofScience,在2023年7月24日搜索了Cochrane图书馆的符合条件的研究,没有开始日期限制.
方法：我们纳入了比较TPT和未治疗MDR-TB患者接触的研究，并报告了进展为TB疾病的结果。
方法：耐多药结核病患者的接触。
方法：TPT。
■使用了纽卡斯尔-渥太华量表的修改版本。
■使用随机效应荟萃分析来计算接受TPT的MDR-TB患者与未接受TPT的患者接触后疾病进展为TB的相对风险（RR）。此外,完成,不利影响,并对停用率进行了评估。
结果：涉及11项研究的1105名个体，接受TPT的接触者与未接受治疗者相比,疾病进展的合并RR为0.34(95%CI:0.16~0.72).亚组分析表明，与统一治疗方案相比，基于指标TB患者的耐药概况，方案的合并RR较低（0.22[95％CI：0.06-0.84]vs.0.49[95%CI：0.17-1.35])，虽然没有统计学意义。合并完成率为83.8%，不良反应率为22.9%,停产率为6.5%。在排除左氧氟沙星和吡嗪酰胺方案研究后，完成率提高到88.0%，不良反应和停药率降至8.0%和4.0%，分别。
结论：TPT可降低MDR-TB患者接触者的结核病进展风险。根据耐药性概况量身定制的TPT方案可能会提供额外的益处。此外，努力提高完成率和管理不良反应对于优化有效性和安全性至关重要。
目的：评价TPT用于耐多药结核病患者接触的有效性和安全性。
方法：EMBASE，PubMed,WebofScience,在2023年7月24日搜索了Cochrane图书馆的符合条件的研究,没有开始日期限制.
方法：我们纳入了比较TPT和未治疗MDR-TB患者接触的研究，并报告了进展为TB疾病的结果。
方法：耐多药结核病患者的接触。
方法：TPT。
■使用了纽卡斯尔-渥太华量表的修改版本。
■使用随机效应荟萃分析来计算接受TPT的MDR-TB患者与未接受TPT的患者接触后疾病进展为TB的相对风险（RR）。此外,完成,不利影响,并对停用率进行了评估。
结果：涉及11项研究的1105名个体，接受TPT的接触者与未接受治疗者相比,疾病进展的合并RR为0.34(95%CI:0.16~0.72).亚组分析表明，与统一治疗方案相比，基于指标TB患者的耐药概况，方案的合并RR较低（0.22[95％CI：0.06-0.84]vs.0.49[95%CI：0.17-1.35])，虽然没有统计学意义。合并完成率为83.8%，不良反应率为22.9%,停产率为6.5%。在排除左氧氟沙星和吡嗪酰胺方案研究后，完成率提高到88.0%，不良反应和停药率降至8.0%和4.0%，分别。
结论：TPT可降低MDR-TB患者接触者的结核病进展风险。根据耐药性概况量身定制的TPT方案可能会提供额外的益处。此外，努力提高完成率和管理不良反应对于优化有效性和安全性至关重要。
