Effectiveness and Safety of Contemporary Drug Regimens for Multidrug- and Extensively Drug-resistant Tuberculosis in Children and Adolescents: A Global Systematic Review and Meta-analysis.
Wamaka Kaminyoge, Reuben Simfukwe, Mwiza Singini et al.
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In 30 seconds
This global systematic review and random-effects meta-analysis assessed treatment outcomes and safety of drug regimens for children and adolescents aged 0–19 years with confirmed or presumed multidrug-resistant, extensively drug-resistant, or rifampicin-resistant tuberculosis. Across 14 studies from 13 countries, including 490 children, pooled treatment success (cure or completion) was 89% (95% confidence interval: 84%-93%; I2 = 51.9%). Success was 91% with newer all-oral regimens and 83% with injectable-containing regimens. Severe grade 3/4 adverse events were reported in 21% of assessed patients, with QT prolongation and anemia most common.
Key findings
- Pooled treatment success across included studies was 89% (95% confidence interval: 84%-93%; I2 = 51.9%).
- Treatment success was 91% with newer all-oral regimens versus 83% with injectable-containing regimens.
- Severe grade 3/4 adverse events occurred in 21% (95% confidence interval: 13%-33%); QT prolongation and anemia were most common.
Why it matters
Pediatric drug-resistant TB treatment has often relied on evidence extrapolated from adults. These pooled findings provide a summary of reported effectiveness and safety in children and adolescents, supporting a more age-specific evidence base. The safety estimate should be interpreted cautiously because adverse-event reporting was available from only some studies and attribution to particular drugs was limited.
What to keep in mind
The evidence came from 14 studies, and severe adverse events were reported in only 7 of them; specific drug attribution was limited.