HealthDay News — Stratifying tuberculosis (TB) patients by disease severity may enable shorter treatment regimens, according to a study published online November 5 in Nature Medicine.

Marjorie Z. Imperial, from the University of California at San Francisco, and colleagues conducteda pooled analysis using publicly available data from the Platform for Aggregation of Clinical TB Studies (3405 participants) for 3 pivotal TB trials that failed to show the efficacy of 4-month treatments over the standard 6-month treatment duration. Patients were retrospectively stratified into minimal, moderate, and severe disease categories. 

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The researchers found that a baseline smear grade of 3+ relative to <2+, HIV seropositivity and adherence of ≤90% were significant risk factors for an unfavorable outcome. For patients with minimal disease defined by <2+ sputum smear grade or noncavitary disease, four-month regimens were noninferior. High smear grades and cavitation together defined a hard-to-treat phenotype that may require treatment durations of longer than 6 months to cure.

“Regimen duration can be selected with greater precision to improve outcomes, providing a stratified medicine approach as an alternative to the ‘one-size-fits-all’ treatment currently used worldwide,” the authors write.

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