Stratifying by Severity May Allow Shorter TB Tx Regimens

Those with minimal disease may be cured with a 4-month vs 6-month treatment regimen.
Those with minimal disease may be cured with a 4-month vs 6-month treatment regimen.

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 conducted a 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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