Title Treatment outcomes of extensively drug-resistant tuberculosis in Europe: a retrospective cohort study
Authors Kherabi, Yousra ; Skouvig Pedersen, Ole ; Lange, Christoph ; Bénézit, François ; Chesov, Dumitru ; Codecasa, Luigi Ruffo ; Dudnyk, Andrii ; Kiria, Nana ; Konstantynovska, Olha ; Marigot-Outtandy, Dhiba ; Panciu, Traian-Constantin ; Poignon, Corentin ; Sasi, Sirje ; Schaub, Dagmar ; Solodovnikova, Varvara ; Vasiliauskaitė, Laima ; Yeghiazaryan, Lusine ; Günther, Gunar ; Guglielmetti, Lorenzo
DOI 10.1016/j.lanepe.2025.101380
Full Text Download
Is Part of The Lancet regional health - Europe.. Amsterdam : Elsevier Ltd.. 2025, vol. 56, art. no. 101380, p. [1-15].. ISSN 2666-7762
Keywords [eng] TB ; TBnet ; MDR/RR-TB ; Pre-XDR-TB ; XDR-TB ; ESGMYC
Abstract [eng] Background 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. Methods 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. Findings 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. Interpretation 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. Funding None.
Published Amsterdam : Elsevier Ltd
Type Journal article
Language English
Publication date 2025
CC license CC license description