|Effects of Fluroquinolones in Newly Diagnosed, Sputum-Positive Tuberculosis Therapy: A Systematic Review and Network Meta-Analysis|
|Li, Dandan1; Wang, Tiansheng2; Shen, Su1; Cheng, Sheng1; Yu, Junxian1; Zhang, Yang1; Zhang, Chao1; Tang, Huilin3|
|WOS标题词||Science & Technology|
|研究领域[WOS]||Science & Technology - Other Topics|
|关键词[WOS]||MULTIDRUG-RESISTANT TUBERCULOSIS ; RANDOMIZED CONTROLLED-TRIALS ; EARLY BACTERICIDAL ACTIVITY ; PULMONARY TUBERCULOSIS ; MYCOBACTERIUM-TUBERCULOSIS ; STERILIZING ACTIVITIES ; CULTURE CONVERSION ; CONTAINING REGIMEN ; PHASE-II ; MOXIFLOXACIN|
Tuberculosis is a major public health problem especially in developing countries, the comparative efficacy and safety of fluroquinolones (FQs) for adult patients with newly diagnosed, sputum-positive tuberculosis remains controversial. We aimed to investigate the benefits and risks of FQs-containing (addition/substitution) regimens in this population.
A network meta-analysis was performed to compare FQs (C: ciprofloxacin; O: ofloxacin; Lo: levofloxacin; M: moxifloxacin; G: gatifloxacin) addition/substitution regimen with standard HRZE regimen (ie isoniazid, rifampicin, pyrazinamide and ethambutol) in newly diagnosed, sputum-positive tuberculosis. Medline, Embase and Cochrane Central Register of Controlled Trials were systematically searched, randomized trials with duration longer than 8 weeks were included. The primary outcome was week-8 sputum negativity, and secondary outcomes included treatment failure, serious adverse events and death from all cause.
Twelve studies comprising 6465 participants were included in the network meta-analysis. Lowenstein-Jensen culture method showed that HRZEM (OR 4.96, 95% CI 2.83-8.67), MRZE (OR 1.48, 95% CI 1.19-1.84) and HRZM (OR 1.32, 95% CI 1.08-1.62) had more sputum conversion than HRZE by the eighth week, whereas HRC (OR 0.39, 95% CI 0.19-0.77) and HRZO (OR 0.47, 95% CI 0.24-0.92) were worse than HRZE. Moxifloxacin-containing regimens showed more conversion than HRZE by liquid method at the end of two months. But by the end of treatment, FQs-containing regimens didn′t show superiority than HRZE on treatment failure. There were no significant differences between any regimens on other outcomes like serious adverse events and all-cause death.
This comprehensive network meta-analysis showed that compared with HRZE, moxifloxacin-containing regimens could significantly increase sputum conversion by the eighth week for patients with newly diagnosed pulmonary tuberculosis while HRC and HRZO regimens were inferior. But all the FQs-containing regimens did not show superiority in other outcomes (such as treatment failure, serious adverse events and all-cause death). Thus, HRZE is still an effective regimen for this population. Although moxifloxacin-containing regimens have deomonstrated their potential, FQs-containing regimens should be used with great caution to avoid widespread FQs-resistance worldwide.
|作者单位||1.Capital Med Univ, Beijing Friendship Hosp, Dept Pharm, Beijing, Peoples R China|
2.Peking Univ, Dept Pharm Adm & Clin Pharm, Sch Pharmaceut Sci, Beijing 100871, Peoples R China
3.Peking Univ, Dept Pharm, Hosp 3, Beijing 100871, Peoples R China
|Li, Dandan,Wang, Tiansheng,Shen, Su,et al. Effects of Fluroquinolones in Newly Diagnosed, Sputum-Positive Tuberculosis Therapy: A Systematic Review and Network Meta-Analysis[J]. PLOS ONE,2015,10(12).|
|APA||Li, Dandan.,Wang, Tiansheng.,Shen, Su.,Cheng, Sheng.,Yu, Junxian.,...&Tang, Huilin.(2015).Effects of Fluroquinolones in Newly Diagnosed, Sputum-Positive Tuberculosis Therapy: A Systematic Review and Network Meta-Analysis.PLOS ONE,10(12).|
|MLA||Li, Dandan,et al."Effects of Fluroquinolones in Newly Diagnosed, Sputum-Positive Tuberculosis Therapy: A Systematic Review and Network Meta-Analysis".PLOS ONE 10.12(2015).|